Intraoperative assessment of atracurium-induced neuromuscular block using double burst stimulation.
Paired train-of-four (TOF) and double burst stimuli (DBS) were administered to the ulnar nerve at the wrist in 25 patients (group 1) paralysed with atracurium 0.5 mg kg-1; responses were measured mechanically (except every third DBS response which was manually evaluated). Another 30 patients (group 2) received a DBS every 60 s. A post-tetanic count (PTC) was performed when the first response (D1) was palpated. There was a significant correlation between the twitch heights of the first TOF response (T1) and D1 and likewise between the twitch heights of both second responses (r = 0.9; P less than 0.001), but there was a significant difference in regression coefficients of these two correlations (P less than 0.001). D1 was palpable first with a median PTC of 7. Our results showed that palpation of a single response implied a satisfactory level of paralysis. DBS may be useful for intraoperative clinical monitoring of neuromuscular block.
Braude
N
N
Department of Anaesthesia, St Bartholomew's Hospital, West Smithfield, London.
Vyvyan
H A
HA
Jordan
M J
MJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D001279:Atracurium; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D009119:Muscle Contraction / Q000187:drug effects; D009407:Nerve Block / Q000379:methods*; D009469:Neuromuscular Junction / Q000187:drug effects*; D009435:Synaptic Transmission / Q000187:drug effects*; D014459:Ulnar Nerve / Q000502:physiology
D001279:Atracurium