Comparative recovery of 50-Hz and 100-Hz posttetanic twitch following profound neuromuscular block.
OBJECTIVE
To determine if posttetanic twitch following 100-Hz tetanic stimulation enables titration of a nondepolarizing relaxant infusion to a greater depth of block than that achieved with posttetanic twitch following 50 Hz.


METHODS
Prospective, observational study.


METHODS
Operating rooms of a university tertiary care center.


METHODS
10 ASA physical status II and III patients free of known neuromuscular disease and undergoing general endotracheal anesthesia for routine elective surgery.


METHODS
Following induction of general anesthesia, neuromuscular block was maintained with a continuous intravenous vecuronium infusion. Depth of neuromuscular block was assessed by tactile evaluation of the evoked responses of the adductor pollicis muscle following supramaximal stimulation of the ulnar nerve via surface electrodes. The vecuronium infusion was titrated to loss of posttetanic twitch following 100-Hz tetanic stimulation, at which point the infusion was discontinued.


RESULTS
100-Hz tetanic stimulation was repeated every two minutes until recovery of the first posttetanic twitch, at which point 50-Hz tetanic stimulation was repeated every two minutes until recovery of the first posttetanic twitch. The median time (interquartile range) from discontinuation of the vecuronium infusion to recovery of the first posttetanic twitch following 100-Hz tetanic stimulation was 27% faster than the corresponding time to recovery of the first posttetanic twitch following 50-Hz tetanic stimulation [19 (10 to 24) min and 26 (20 to 30) min respectively, p < 0.002].


CONCLUSIONS
Posttetanic twitch following 100-Hz tetanic stimulation enables titration of a vecuronium infusion to a greater depth of block than posttetanic twitch following 50-Hz tetanic stimulation. The present findings should enable more effective titration of this relaxant, thereby reducing the likelihood of unwanted patient movement or unduly prolonged recovery due to relaxant overdosing.
Fernandes
L A
LA
Department of Anesthesiology, Yale University School of Medicine, New Haven, CT 06520-8051, USA.
Stout
R G
RG
Silverman
D G
DG
Brull
S J
SJ
D000328:Adult; D000368:Aged; D000771:Anesthesia, Intravenous; D004558:Electric Stimulation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009119:Muscle Contraction / Q000187:drug effects; D018482:Muscle, Skeletal / Q000187:drug effects / Q000502:physiology*; D019148:Neuromuscular Blockade; D009466:Neuromuscular Blocking Agents; D011446:Prospective Studies; D013997:Time Factors; D014673:Vecuronium Bromide
D009466:Neuromuscular Blocking Agents; D014673:Vecuronium Bromide