title: Assessment of neuromuscular block at the thumb and great toe using accelography in infants.
abstract: We assessed neuromuscular block at the thumb and great toe using accelography after the administration of vecuronium in infants. Train-of-four stimuli were simultaneously applied to the ulnar and tibial nerves using cutaneous electrodes. Anaesthesia was maintained with nitrous oxide (66%) in oxygen and sevoflurane (1%). Vecuronium 0.1 mg.kg-1 was used for paralysis and reversed with intravenous neostigmine 0.04 mg.kg-1 with atropine 0.02 mg.kg-1 when the train-of-four ratio on the right great toe returned to 25%. The mean (SD) times from initial administration of vecuronium to completion of maximal block on the thumb and great toe were 78 (21.1) s and 75 (14.3) s, respectively (p > 0.05). The times from maximal block to 25% recovery of twitch height at the thumb and great toe were 46 (9.1) min and 45 (9.0) min, respectively. The reversal time from 25% to 75% of the train-of-four ratio after the administration of neostigmine was 136 (49.1) s. We conclude that neuromuscular monitoring of the great toe in infants may be a suitable alternative when the thumb is inaccessible.
authors.affiliation: Department of Anaesthesiology, Dokkyo University School of Medicine, Tochigi, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Kitajima
authors.forename: K
authors.initials: K
authors.lastname: Ishii
authors.forename: H
authors.initials: H
authors.lastname: Ogata
mesh_terms: D000768:Anesthesia, General; D004558:Electric Stimulation; D004576:Electromyography / Q000379:methods; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D016343:Monitoring, Intraoperative / Q000379:methods; D009407:Nerve Block; D003473:Neuromuscular Nondepolarizing Agents; D013933:Thumb / Q000294:innervation* / Q000502:physiology; D013979:Tibial Nerve / Q000502:physiology; D014034:Toes / Q000294:innervation* / Q000502:physiology; D014459:Ulnar Nerve / Q000502:physiology; D014673:Vecuronium Bromide
chemical_list: D003473:Neuromuscular Nondepolarizing Agents; D014673:Vecuronium Bromide