title: Perioperative train-of-four monitoring and residual curarization.
abstract: It has been suggested that perioperative train-of-four (TOF) monitoring does not reduce the incidence of postoperative residual curarization (PORC). The purpose of this study was to examine whether the use of tactile assessment of the response of the adductor pollicis to supramaximal TOF stimulation of the ulnar nerve at the wrist during anaesthesia affected the incidence of PORC. Thirty-nine ASA I or II surgical patients were studied during thiopentone/fentanyl N2O/enflurane anaesthesia. Pancuronium (70-100 micrograms.kg-1) was used to facilitate tracheal intubation and additional pancuronium increments used to maintain surgical relaxation. The requirement for incremental doses of pancuronium and adequacy of recovery following reversal were assessed according to random allocation, either with (Group A; n = 20) or without (Group B; n = 19) access to TOF monitoring. Patients in the two groups received neostigmine in similar doses (Group A: 53 micrograms.kg-1 (5.9); Group B: 55 micrograms.kg-1 (5.4)). On arrival of the patient to the recovery area, neuromuscular function was assessed electromyographically (using the Datex NMT 221 to measure TOF ratio) and clinically. The incidence of PORC (TOF ratio < 70%) was greater in Group B (47%) than in Group A (15%) (P = 0.029). We conclude that the use of perioperative TOF monitoring decreases the incidence of pancuronium-induced PORC.
authors.affiliation: Department of Anesthesia, Massachusetts General Hospital, Boston 02114, USA.
authors.forename: G D
authors.initials: GD
authors.lastname: Shorten
authors.forename: H
authors.initials: H
authors.lastname: Merk
authors.forename: T
authors.initials: T
authors.lastname: Sieber
mesh_terms: D000328:Adult; D000762:Anesthesia Recovery Period; D018685:Anesthetics, Inhalation / Q000008:administration & dosage; D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D002800:Cholinesterase Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D004558:Electric Stimulation; D004576:Electromyography; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D006801:Humans; D008297:Male; D016343:Monitoring, Intraoperative; D018482:Muscle, Skeletal / Q000187:drug effects / Q000294:innervation; D009388:Neostigmine / Q000008:administration & dosage / Q000627:therapeutic use; D009469:Neuromuscular Junction / Q000187:drug effects*; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000037:antagonists & inhibitors; D009609:Nitrous Oxide / Q000008:administration & dosage; D010197:Pancuronium / Q000008:administration & dosage / Q000009:adverse effects* / Q000037:antagonists & inhibitors; D011183:Postoperative Complications; D013874:Thiopental / Q000008:administration & dosage; D014459:Ulnar Nerve / Q000187:drug effects* / Q000502:physiology
chemical_list: D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D002800:Cholinesterase Inhibitors; D003473:Neuromuscular Nondepolarizing Agents; D009388:Neostigmine; D010197:Pancuronium; D013874:Thiopental; D009609:Nitrous Oxide; D005283:Fentanyl