Neuromuscular blockade can be assessed accelerographically over the vastus medialis muscle in patients positioned prone

  • Yuhji SaitohEmail author
  • Hiroshi Nakajima
  • Hisashi Hattori
  • Kenichi Aoki
  • Takaaki Katayama
  • Masahiro Murakawa
General anesthesia



To study accelerographic monitoring of neuromuscular blockade over the vastus medialis muscle in anesthetized patients in the prone position.


Sixty adult patients were divided into four groups of 15: prone (P)-post-tetanic count (PTC), P-train-of-four (TOF), supine (S)-PTC or S-TOF group. In the P-PTC and P-TOF groups, the muscular branch of the femoral nerve was stimulated and the movement of the vastus medialis muscle was measured accelerographically In the S-PTC and S-TOF groups, the depth of neuromuscular blockade was assessed mechanically at the thumb. After administration of vecuronium 0.1 mg·kg−1, TOF stimuli were delivered every 20 sec in all groups. Onset of neuromuscular blockade (time from vecuronium to the minimum level of T1 (first response of TOF) was compared between the P-PTC or P-TOF group and S-PTC or S-TOF group. Recoveries of PTC and those of TOF were compared between the P-PTC and S-PTC groups and P-TOF and S-TOF groups, respectively.


Onset of neuromuscular blockade in the P-PTC or P-TOF group was shorter than in the S-PTC or S-TOF group (132 ± 43 vs 233 ± 40 sec, mean ± SD, P < 0.001). Recoveries of PTC in the P-PTC and S-PTC groups followed a similar time course. Recoveries of T1 /control in the P-TOF and S-TOF groups were also comparable. In contrast, train-of-four ratio (T4/T1, TOFR) in the P-TOF group was higher than in the S-TOF group 60–120 min after vecuronium (P < 0.05).


The degree of neuromuscular blockade can be assessed accelerographically over the vastus medialis muscle even when patients are in the prone position. When evaluated accelerographically over the vastus medialis muscle, onset of neuromuscular blockade is quicker and TOFR is higher than that assessed at the thumb.


Vecuronium Neuromuscular Blockade Femoral Nerve Adductor Pollicis Muscle Muscular Branch 
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Le blocage neuromusculaire peut être évalué par accélérographie sur le muscle vaste interne chez des patients en décubitus ventral



Étudier la mesure accélérographique du blocage neuromusculaire du muscle vaste interne chez des patients anesthésiés en décubitus ventral.


Soixante adultes ont été répartis en quatre groupes de 15: compte post-tétanique en décubitus ventral (CPT-V), train-de-quatre-V (TDQ-V), CPT-D en décubitus dorsal ou TDQ-D. Dans les groupes CPT-V et TDQ-V, la branche musculaire du nerf fémoral a été stimulée et le mouvement du muscle vaste interne mesuré par accélérographie. Dans les groupes CPT-D et TDQ-D, la profondeur du blocage neuromusculaire a été évaluée mécaniquement au pouce. Après l’administration de 0,1 mg·kg−1 de vécuronium, des stimuli en TDQ ont été administrés à toutes les 20 sec chez tous les patients. L’installation du bloc, c’est-à-dire le temps entre l’administration du vécuronium et le niveau minimal de T1 (première réponse au TDQ), a été comparée entre les groupes CPT-V ou TDQ-V et les groupes CPT-D et TDQ-D. La récupération du CPT et celle du TDQ ont été respectivement comparées entre CPT-V et CPT-D et entre TDQ-V et TDQ-D.


L’installation du bloc dans le groupe CPT-V ou TDQ-V a été plus courte que dans le groupe CPT-D ou TDQ-D (132 ± 43 vs 233 ± 40 sec, moyenne ± l’écart type, P < 0,001). La récupération duf CPT dans les groupes CPT-V et CPT-D a connu une évolution similaire. La récupération de T1 /témoin dans les groupes TDQ-V et TDQ-D ont été aussi comparables. Mais le rapport du train-de-quatre (T4/T1, RTDQ) dans le groupe TDQ-V a été plus élevé que dans le groupe TDQ-D, 60–120 min après le vécuronium (P < 0,05).


Le degré de blocage neuromusculaire peut être évalué par accélérographie sur le muscle vaste interne chez des patients en décubitus ventral. L’installation du bloc, évaluée par accélérographie, est alors plus rapide et le RTDQ plus élevé que pendant l’évaluation au pouce.


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Copyright information

© Canadian Anesthesiologists 2003

Authors and Affiliations

  • Yuhji Saitoh
    • 1
    Email author
  • Hiroshi Nakajima
    • 1
  • Hisashi Hattori
    • 1
  • Kenichi Aoki
    • 1
  • Takaaki Katayama
    • 1
  • Masahiro Murakawa
    • 1
  1. 1.Department of AnesthesiologyFukushima Medical University School of MedicineFukushimaJapan

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