title: Relationship of post-tetanic count and train-of-four response during intense neuromuscular blockade caused by atracurium.
abstract: Atracurium-induced intense neuromuscular blockade was evaluated in 60 randomly selected patients using the post-tetanic count (PTC) and train-of-four (TOF) methods. Thirty patients were anaesthetized with thiopentone, nitrous oxide and halothane, and 30 patients received thiopentone, nitrous oxide and fentanyl. In all patients, the response to post-tetanic single twitch stimulation appeared before the response to TOF stimulation, and a close correlation was found between the number of post-tetanic twitches (PTC) and the time interval between the PTC and the first detectable TOF response. A PTC of zero indicated that the time to first response to TOF stimulation was always more than 8 min. A PTC of 1 meant that the TOF response would appear in, on average, 9 min (95% confidence limits: 4-14 min). Halothane significantly prolonged the time from injection of atracurium to the first response to post-tetanic single twitch stimulation. It is concluded that the relationship between PTC and the time to first response to TOF nerve stimulation makes the PTC method a valuable supplement to TOF nerve stimulation for neuromuscular monitoring during clinical anaesthesia involving atracurium.
authors.affiliation: Department of Anaesthesia and Intensive Care, King Khalid University Hospital, King Saud University, Riyadh, Kingdom of Saudi Arabia.
authors.forename: A K
authors.initials: AK
authors.lastname: Bonsu
authors.forename: J
authors.initials: J
authors.lastname: Viby-Mogensen
authors.forename: P U
authors.initials: PU
authors.lastname: Fernando
authors.forename: K
authors.initials: K
authors.lastname: Muchhal
authors.forename: A
authors.initials: A
authors.lastname: Tamilarasan
authors.forename: A
authors.initials: A
authors.lastname: Lambourne
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001279:Atracurium / Q000494:pharmacology*; D004558:Electric Stimulation; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D009119:Muscle Contraction / Q000187:drug effects; D009469:Neuromuscular Junction / Q000502:physiology*; D009435:Synaptic Transmission / Q000187:drug effects*; D014459:Ulnar Nerve / Q000502:physiology
chemical_list: D001279:Atracurium