title: Pulmonary function and head lift during spontaneous recovery from pipecuronium neuromuscular block.
abstract: We have studied in seven healthy conscious volunteers the correlation between the electromyographic (EMG) and clinical criteria used to identify adequate recovery from sub-paralysing doses of pipecuronium. Pipecuronium (mean dose 1.88 (range 0.92-3.16) mg) was administered to reach a T4/T1 ratio of 0.5; full recovery to 1.0 was produced in a mean time of 25.3 (14-39) min. During recovery from neuromuscular block, we measured tidal volume, forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1) negative inspiratory pressure (NIP), peak expiratory flow rate (PEFR), mid-expiratory flow rate (MEFR) and 5-s head lift. The assessments were started when the train-of-four (TOF) ratio reached 0.5 +/- 0.001 and repeated at each 0.1 +/- 0.001 increase up to a ratio of 1.0. All volunteers showed ptosis and diplopia after the first dose and difficulty in swallowing with subsequent doses. They also experienced a pleasant, relaxing sedative sensation. All could sustain head lift for 5 s at a TOF ratio of 0.5 and higher, except for one subject who could not lift his head only at a ratio of 0.5. There was a statistically significant decrease in FVC, FEV1 and PEFR with a nonsignificant decrease in other pulmonary measurements, except for NIP which only decreased significantly at a ratio of 0.5. These changes are probably of no clinical importance. All the measured respiratory variables returned to control values at a TOF ratio of 0.9.
authors.affiliation: Manchester Royal Infirmary.
authors.forename: N
authors.initials: N
authors.lastname: El Mikatti
authors.forename: A
authors.initials: A
authors.lastname: Wilson
authors.forename: B J
authors.initials: BJ
authors.lastname: Pollard
authors.forename: T E
authors.initials: TE
authors.lastname: Healy
mesh_terms: D000328:Adult; D000762:Anesthesia Recovery Period; D004172:Diplopia / Q000139:chemically induced; D004558:Electric Stimulation; D004576:Electromyography; D005260:Female; D005541:Forced Expiratory Volume / Q000187:drug effects; D006801:Humans; D008168:Lung / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D009334:Neck Muscles / Q000187:drug effects; D009407:Nerve Block; D009469:Neuromuscular Junction / Q000187:drug effects*; D010366:Peak Expiratory Flow Rate / Q000187:drug effects; D017300:Pipecuronium / Q000009:adverse effects / Q000494:pharmacology*; D012129:Respiratory Function Tests; D012132:Respiratory Muscles / Q000187:drug effects; D014797:Vital Capacity / Q000187:drug effects
chemical_list: D017300:Pipecuronium