title: Response to double-burst appears before response to train-of-four stimulation during recovery from non-depolarizing neuromuscular blockade.
abstract: BACKGROUND
  Double-burst stimulation (DBS) it a relatively new nerve stimulation mode introduced for improved manual detection of residual neuromuscular blockade. Previous studies have shown that DBS3,3 50/50 (3 stimuli at 50 Hz followed 0.75 seconds later by 3 stimuli at 50 Hz) can detect deeper degrees of neuromuscular blockade than train-of-four (TOF) stimulation.
  
  
  OBJECTIVE
  The aim of the present study was to examine if DBS3,3 80/40 (3 stimuli at 80 Hz followed 0.750 s later by 3 stimuli at 40 Hz) can detect even deeper degrees of neuromuscular blockade than DBS3,3 50/50 and to determine the time lapse from reappearance of response to each of the two DBS modes until reappearance of response to the TOF mode of nerve stimulation.
  
  
  METHODS
  The study comprised 20 women undergoing gynaecological surgery and anaesthetised with fentanyl, thiopentone, halothane, and nitrous oxide. Neuromuscular transmission was monitored by using mechanomyography and stimulation of the ulnar nerve. Atracurium was used for neuromuscular blockade.
  
  
  RESULTS
  Elapsed time from reappearance of response to DBS3,3 80/40 and DBS3,3 50/50 to reappearance of response to TOF stimulation was 459 +/- 196 (mean +/- SD) and 360 +/- 150 seconds, respectively, (P < 0.05).
  
  
  CONCLUSIONS
  DBS3,3 80/40 is capable of detecting deeper degrees of blockade than DBS3,3 50/50, which again is capable of detecting deeper degrees of blockade than TOF.
authors.affiliation: Department of Anaesthesia and Intensive Care, Odense University Hospital, Denmark.
authors.forename: H
authors.initials: H
authors.lastname: Kirkegaard-Nielsen
authors.forename: H S
authors.initials: HS
authors.lastname: Helbo-Hansen
authors.forename: I K
authors.initials: IK
authors.lastname: Severinsen
authors.forename: P
authors.initials: P
authors.lastname: Lindholm
authors.forename: K
authors.initials: K
authors.lastname: Bülow
mesh_terms: D000293:Adolescent; D000328:Adult; D000762:Anesthesia Recovery Period; D001279:Atracurium; D004558:Electric Stimulation; D005260:Female; D005836:Genitalia, Female / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D019148:Neuromuscular Blockade; D009469:Neuromuscular Junction / Q000502:physiology*; D003473:Neuromuscular Nondepolarizing Agents; D009435:Synaptic Transmission; D014459:Ulnar Nerve / Q000502:physiology
chemical_list: D003473:Neuromuscular Nondepolarizing Agents; D001279:Atracurium