Abstract
The purpose of this study was to compare the pattern of recovery from vecuronium 0.07 mg · kg−1 induced neuromuscular blockade using post-tetanic burst count (PTBC)-(three short tetanic bursts of 0.2 msec duration every 20 msec given every second following a tetanus), and post-tetanic count (PTC)-(0.2 msec single twitch stimuli given every second following a tetanus) using an accelerometer in 60 adult patients during nitrous oxide-oxygen-isoflurane anaesthesia. In addition, the relationship among PTBC, PTC, and T-1 (the 1st response in the train-of-four (TOF) stimulation) was examined to investigate whether the PTBC had an advantage over the PTC or TOF for evaluating intense neuromuscular blockade. The PTBC was greater than PTC during the 15–35 min after the administration of vecuronium (unpaired t test with Bonferroni’s correction, P < 0.05). Time to the return of PTB response was shorter than that of PTT (17.7 ± 3.2 vs 22.7 ± 3.7 min, unpaired t test, P = 0.0005). Time from the return of PTB to that of T-1 was longer than the time from the return of PTC to that of T-1 (13.3 ± 2.6 vs 9.2 ± 2.8 min, unpaired t test, P = 0.0003). At the return of T-1, PTBC was greater than PTC (14.3 ± 6.9 vs 9.4 ± 2.3, unpaired t test, P = 0.0153). These results suggest that, using PTBC, a more profound level of neuromuscular blockade can be evaluated than that using PTC.
Résumé
Cette étude visait à comparer, après curarisation au vécuronium 0,7 mg · kg−1 le pattern de la décurarisation avec le compte du burst post-tétanique (PTBC-trois courtes salves de tétanos de 0,2 sec aux 20 msec à toutes les secondes après un tétanos) avec celui du compte post-tétanique (PTC-un twitch simple de 0,2 msec à toutes les secondes après un tétanos). L’accélérométrie a été utilisé chez 60 patients adultes pendant une anesthésie à l’association N2O-oxygène-isoflurane. En outre, la relation entre PTBC, PTC et T1 (la première résponse du TOF) a été étudiée pour savoir si le PTBC avait un avantage sur le PTC ou le TOF pour évaluer la curarisation profonde. La PTBC a été supérieur au PTC et au TOF pendant les 15 à 35 min qui ont suivi l’administration de vécuronium (test T non pairé avec correction de Bonferroni, P < 0,05). L’intervalle précédant le retour du PTB a été plus court que celui du PTT (17,7 ± 3,2 vs 22,7 ± 3,7 min, test T non apparié, P = 0,0005). L’intervalle précédant le retour du PTB à celui du T1 a été plus long que celui du retour du PTC à celui du T1 (13,3 ± 2,6 vs 9,2 ± 2,8 min, test T non apparié, P = 0,0003). Au retour du T1 le PTBC a été plus grand que le PTC (14,3 ± 6,9 vs 9,4 ± 2,3 T non apparié, P = 0,0153). Ces résultats suggèrent que, avec le PTBC, un niveau plus profond de curarisation peut être évalué qu’avec le PTC.
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Saitoh Y, Toyooka H, Amaha K. Post-tetanic burst: a new monitoring method for intense neuromuscular block. Br J Anaesth 1995; 74; 293–5.
Fernando PUE, Viby-Mogensen J, Bonsu AK, Tamilarasan A, Muchhal KK, Lambourne A. Relationship between posttetanic count and response to carinal stimulation during vecuronium-induced neuromuscular blockade. Acta Anaesthesiol Scand 1987; 31: 593–6.
Saitoh Y, Kaneda K, Toyooka H, Amaha K. Post-tetanic count and single twitch height at the onset of reflex movement after administration of vecuronium under different types of anaesthesia. Br J Anaesth 1994; 72: 688–90.
Saddler JM, Bevan JC, Donati F, Bevan DR, Pinto SR. Comparison of double-burst and train-of-four stimulation to assess neuromuscular blockade in children. Anesthesiology 1990; 73: 401–3.
Engbaek J, Ostergaard D, Viby-Mogensen J. Double burst stimulation (DBS): a new pattern of nerve stimulation to identify residual neuromuscular block. Br J Anaesth 1989; 62: 274–8.
Saitoh Y, Toyooka H, Amaha K. Relationship between post-tetanic twitch and single twitch response after administration of vecuronium. Br J Anaesth 1993; 71: 443–4.
Toyooka H, Noguchi Y, Ebata T, Amaha K. A close relationship between post-tetanic twitch and train-of-four responses during neuromuscular blockade by vecuronium. J Anesth 1991; 5: 146–52.
Ridley SA, Braude N. Post-tetanic count and intense neuromuscular blockade with vecuronium in children. Br J Anaesth 1988; 61: 551–6.
Nishizawa M, Goto H, Otagiri T, Nakajima K, Harashima N, Sakai J. Effect of prior administration of succinylcholine on duration of action of vecuronium during enflurane anaesthesia. Acta Anaesthesiol Scand 1994; 38: 380–3.
Ono K, Manabe N, Ohta Y, Morita K, Kosaka F. Influence of suxamethonium on the action of subsequently administered vecuronium or pancuronium. Br J Anaesth 1989; 62: 324–6.
d’Hollander AA, Agoston S, De Ville A, Cuvelier F. Clinical and pharmacological actions of a bolus injection of suxamethonium: two phenomena of distinct duration. Br J Anaesth 1983; 55: 131–4.
Feldman SA, Tyrrell MF. A new theory of the termination of action of the muscle relaxants. Proc Roy Soc Med 1970; 63: 692–5.
Viby-Mogensen J. Clinical assessment of neuromuscular transmission. Br J Anaesth 1982; 54: 209–23.
Brull SJ, Connelly NR, O’Connor TZ, Silverman DG. Effect of tetanus on subsequent neuromuscular monitoring in patients receiving vecuronium. Anesthesiology 1991; 74: 64–70.
Saitoh Y, Masuda A, Toyooka H, Amaha K. Effect of tetanic stimulation on subsequent train-of-four responses at various levels of vecuronium-induced neuromuscular block. Br J Anaesth 1994; 73: 416–7.
Silverman DG, Connelly NR, O’Connor TZ, Garcia R, Brull SJ. Accelographic train-of-four at near threshold currents. Anesthesiology 1992; 76: 34–8.
Kirkegaard-Neilsen H, Helbo-Hansen HS, Severinsen IK, Lindholm P, Pedersen HS, Schmidt MB. Comparison of tactile and mechanomyographical assessment of response to double burst and train-of-four stimulation during moderate and profound neuromuscular blockade. Can J Anaesth 1995; 42: 21–7.
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Saitoh, Y., Fujii, Y., Toyooka, H. et al. Post-tetanic burst count: A stimulating pattern for profound neuromuscular blockade. Can J Anaesth 42, 1096–1100 (1995). https://doi.org/10.1007/BF03015095
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DOI: https://doi.org/10.1007/BF03015095