Journal of Anesthesia

, Volume 24, Issue 6, pp 838–844 | Cite as

RETRACTED ARTICLE: Monitoring of vecuronium-induced neuromuscular block at the sternocleidomastoid muscle in anesthetized patients

Original Article



To assess the degree of neuromuscular block acceleromyographically at the sternocleidomastoid muscle.


Eighteen adult patients scheduled for air–oxygen–sevoflurane–fentanyl and epidural anesthesia were studied. In the patients, the right accessory nerve and the sternocleidomastoid muscle were stimulated and the contraction of the sternocleidomastoid muscle was evaluated acceleromyographically. Simultaneously, the response of the adductor pollicis muscle was measured electromyographically. Supramaximal stimulating current, degree of maximum neuromuscular block after vecuronium 0.1 mg/kg, and onset of or recovery from vecuronium-induced neuromuscular block were compared between the two muscles.


The supramaximal stimulating current at the sternocleidomastoid muscle was significantly higher than that at the adductor pollicis muscle (54.8 ± 7.1 vs. 33.7 ± 10.3 mA, mean ± SD, P < 0.001). The onset of neuromuscular block at the sternocleidomastoid muscle did not significantly differ from that at the adductor pollicis muscle (214 ± 117 vs. 161 ± 87 s, P = 0.131). The degree of maximum neuromuscular block at the sternocleidomastoid muscle was significantly less than that at the adductor pollicis muscle (93.6 ± 3.1 vs. 99.2 ± 2.5%, P < 0.001). During recovery from neuromuscular block, T1/control and train-of-four ratio measured at the sternocleidomastoid muscle were significantly higher than those at the adductor pollicis muscle 10–30 and 40–120 min after vecuronium, respectively (P < 0.05).


The sternocleidomastoid muscle is more resistant to vecuronium than the adductor pollicis muscle. Recovery from neuromuscular block is faster at the sternocleidomastoid muscle than at the adductor pollicis muscle.


Sternocleidomastoid muscle Adductor pollicis muscle Vecuronium 


  1. 1.
    Saitoh Y, Fujii Y, Takahashi K, Makita K, Tanaka H, Amaha K. Recovery of post-tetanic count and train-of-four responses at the great toe and thumb. Anaesthesia. 1998;53:244–8.CrossRefGoogle Scholar
  2. 2.
    Saitoh Y, Fujii Y, Ueki M, Makita K, Amaha K. Accelographic and mechanical post-tetanic count and train-of-four ratio assessed at the great toe. Eur J Anaesth. 1998;14:649–55.CrossRefGoogle Scholar
  3. 3.
    Saitoh Y, Narumi Y, Fujii Y, Ueki M, Makita K. Electromyographic assessment of neuromuscular block at the gastrocnemius muscle. Br J Anaesth. 1999;82:329–32.CrossRefGoogle Scholar
  4. 4.
    Hemmerling TM, Donati F, Beaulieu P, Babin D. Phonomyography of the corrugator supercilii muscle: signal characteristics, best recording site and comparison with acceleromyography. Br J Anaesth. 2002;88:389–93.CrossRefGoogle Scholar
  5. 5.
    Plaud B, Debaene B, Donati F. The corrugator supercilii, not the orbicularis oculi, reflects rocuronium neuromuscular blockade at the laryngeal adductor muscles. Anesthesiology. 2001;95:96–101.CrossRefGoogle Scholar
  6. 6.
    Saitoh Y, Nakajima H, Hattori H, Aoki K, Katayama T, Murakawa M. Neuromuscular blockade can be assessed accelerographically over the vastus medialis muscle in patients positioned prone. Can J Anesth. 2003;50:342–7.CrossRefGoogle Scholar
  7. 7.
    Michaud G, Trager G, Deschamps S, Hemmerling TM. Monitoring neuromuscular blockade at the vastus medialis muscle using phonomyography. Can J Anesth. 2005;52:795–800.CrossRefGoogle Scholar
  8. 8.
    Altose MD, Kelsen SG, Stanley NN, Cherniack NS, Fishman AP. Effect of hypercapnia and flow-resistance loading on tracheal pressure during airway occlusion. J Appl Physiol. 1976;40:345–51.CrossRefGoogle Scholar
  9. 9.
    Skarvan K, Mikulenka V. The ventilatory function of sternomastoid and scalene muscles in patients with pulmonary emphysema. Respiration. 1970;27:480–92.CrossRefGoogle Scholar
  10. 10.
    Wilson SH, Cooke NT, Moxham J, Spiro SG. Sternocleidomastoid muscle function and fatigue in normal subjects and in patients with chronic obstructive pulmonary disease. Am Rev Respir Dis. 1984;129:460–4.PubMedGoogle Scholar
  11. 11.
    Oshima T, Toyooka H, Amaha K. Sternocleidomastoid muscle contractility at different levels of isoflurane anaesthesia in humans. Br J Anaesth. 1992;69:236–9.CrossRefGoogle Scholar
  12. 12.
    Hemmerling TM, Donati F. Neuromuscular blockade at the larynx, the diaphragm and the corrugator supercilii muscle: a review. Can J Anesth. 2003;50:779–94.CrossRefGoogle Scholar
  13. 13.
    Browner WS, Newman TB, Cummings SR, Hulley SB. Estimating sample size and power: the nitty-gritty. In: Hulley SB, editor. Designing clinical research. 2nd ed. Philadelphia: Lippincott Williams & Wilkins; 2001. p. 65–91.Google Scholar
  14. 14.
    Viby-Mogensen J, Engbaek J, Eriksson LI, Gramstad L, Jensen E, Jensen FS, Koscielniak-Nielsen Z, Skovgaard LT, Ostergaard D. Good clinical research practice (GCRP) in pharmacodynamic studies of neuromuscular blocking agents. Acta Anaesthesiol Scand. 1996;40:59–74.CrossRefGoogle Scholar
  15. 15.
    Kopman AF, Lawson D. Milliamperage requirements for supramaximal stimulation of the ulnar nerve with surface electrodes. Anesthesiology. 1984;61:83–5.CrossRefGoogle Scholar
  16. 16.
    Saitoh Y, Nakazawa K, Toyooka H, Amaha K. Optimal stimulating current for train-of-four stimulation in conscious subjects. Can J Anesth. 1995;42:992–5.CrossRefGoogle Scholar
  17. 17.
    Larsen PB, Gätke MR, Fredensborg BB, Berg H, Engbæk J, Viby-Mogensen J. Acceleromyography of the orbicularis oculi muscle II: comparing the orbicularis oculi and adductor pollicis muscles. Acta Anaesthesiol Scand. 2002;46:1131–6.CrossRefGoogle Scholar
  18. 18.
    Saitoh Y, Oshima T, Nakata Y. Acceleromyographic monitoring of neuromuscular block over the orbicularis oris muscle in anesthetized patients receiving vecuronium. J Clin Anesth. 2010;22:318–23.CrossRefGoogle Scholar
  19. 19.
    Hemmerling TM, Schmidt J, Hanusa C, Wolf T, Schmidt H. Simultaneous determination of neuromuscular block at the larynx, diaphragm, adductor pollicis, orbicularis oculi and corrugator supercilii muscles. Br J Anaesth. 2000;85:856–60.CrossRefGoogle Scholar
  20. 20.
    Abdulatif M, El-Sanabary M. Blood flow and mivacurium-induced neuromuscular block at the orbicularis oculi and adductor pollicis muscles. Br J Anaesth. 1997;79:24–8.CrossRefGoogle Scholar
  21. 21.
    Johnson MA, Polgar J, Weightman D, Appleton D. Data on the distribution of fibre types in thirty-six human muscle. An autopsy study. J Neurol Sci. 1973;18:111–29.CrossRefGoogle Scholar
  22. 22.
    Goodmurphy CW, Ovalle WK. Morphological study of two human facial muscles: orbicularis oculi and corrugator supercilii. Clin Anat. 1999;12:1–11.CrossRefGoogle Scholar
  23. 23.
    Ibebunjo C, Hall W. Muscle fibre diameter and sensitivity to neuromuscular blocking drugs. Br J Anaesth. 1993;71:732–3.CrossRefGoogle Scholar
  24. 24.
    Polgar J, Johnson MA, Weightman D, Appleton D. Data on fibre size in thirty-six human muscles. An autopsy study. J Neurol Sci. 1973;19:307–18.CrossRefGoogle Scholar
  25. 25.
    Saitoh Y, Toyooka H, Amaha K. Recoveries of post-tetanic twitch and train-of-four responses after administration of vecuronium with different inhalation anaesthetics and neuroleptanaesthesia. Br J Anaesth. 1993;70:402–4.CrossRefGoogle Scholar
  26. 26.
    Viby-Mogensen J. Neuromuscular monitoring. In: Miller RD, editor. Anesthesia. 5th ed. Philadelphia: Churchill Livingstone; 2000: p. 1363.Google Scholar
  27. 27.
    Brull SJ, Ehrenwerth J, Silverman DG. Stimulation with submaximal current for train-of-four monitoring. Anesthesiology. 1990;72:629–32.CrossRefGoogle Scholar
  28. 28.
    Viby-Mogensen J, Jensen E, Werner M, Nielsen HK. Measurement of acceleration: a new method of monitoring neuromuscular function. Acta Anaesthesiol Scand. 1988;32:45–8.CrossRefGoogle Scholar
  29. 29.
    Kopman AF. The relationship of evoked electromyographic and mechanical responses following atracurium in humans. Anesthesiology. 1985;63:208–11.CrossRefGoogle Scholar

Copyright information

© Japanese Society of Anesthesiologists 2010

Authors and Affiliations

  • Yuhji Saitoh
    • 1
  • Tsutomu Oshima
    • 2
  • Yoshinori Nakata
    • 3
  1. 1.Department of AnesthesiologyTsujinaka Hospital KashiwanohaKashiwaJapan
  2. 2.Department of AnesthesiaThe Cancer Institute Hospital of Japanese Foundation for Cancer ResearchTokyoJapan
  3. 3.Department of Anesthesia and Critical CareTeikyo University School of MedicineTokyoJapan

Personalised recommendations