title: The lumbar paravertebral region provides a novel site to assess neuromuscular block at the diaphragm.
abstract: OBJECTIVE
  We evaluated a novel, paravertebral site for assessment of neuromuscular block at the diaphragm. The neuromuscular blocking effect of 0.1 mg x kg(-1) cisatracurium at the adducting laryngeal muscles, the diaphragm and the adductor pollicis (AP) were compared.
  
  
  METHODS
  In 24 patients undergoing thyroid surgery, evoked responses from the adducting laryngeal muscles and the AP muscle were obtained using surface electromyography (EMG). Skin electrodes were placed paravertebrally near T12/L1 or L1/L2 (novel position; n = 12) or conventionally (n = 12). After stimulation of the recurrent laryngeal, phrenic and ulnar nerves, the lag, onset time and maximum effect were measured (0.1 Hz, single twitch) as well as the time to reach 25% of T1/T0 (T 25%) using train-of-four stimulation every 20 sec.
  
  
  RESULTS
  A mean maximum block of more than 94% was reached at all sites. Lag, onset time and T 25% at the adducting laryngeal muscles and the diaphragm were significantly (P <0.005) shorter than at the AP muscle and did not differ significantly between the two diaphragmatic monitoring sites (conventional: 64 +/- 21 sec, 166 +/- 41 sec and 20 +/- 3 min vs novel: 60 +/- 16 sec, 161 +/- 40 sec and 22 +/- 2 min respectively).
  
  
  CONCLUSIONS
  Onset and duration of action of 0.1 mg x kg(-1) cisatracurium was shorter at the larynx and the diaphragm than at the AP muscle. EMG results obtained from the novel, paravertebral site did not differ from the conventional monitoring site at the seventh or eighth intercostal space and suggest this alternative site is appropriate for monitoring of the diaphragm.
authors.affiliation: Department of Anesthesiology, Erlangen-Nuremberg University, Germany. thomashemmerling@hotmail.com
authors.forename: T M
authors.initials: TM
authors.lastname: Hemmerling
authors.forename: J
authors.initials: J
authors.lastname: Schmidt
authors.forename: C
authors.initials: C
authors.lastname: Hanusa
authors.forename: T
authors.initials: T
authors.lastname: Wolf
authors.forename: K E
authors.initials: KE
authors.lastname: Jacobi
mesh_terms: D000328:Adult; D001279:Atracurium / Q000031:analogs & derivatives / Q000494:pharmacology*; D003964:Diaphragm / Q000187:drug effects* / Q000502:physiology; D006801:Humans; D008161:Lumbosacral Region; D008875:Middle Aged; D009466:Neuromuscular Blocking Agents / Q000494:pharmacology*; D009469:Neuromuscular Junction / Q000187:drug effects* / Q000502:physiology; D013997:Time Factors
chemical_list: D009466:Neuromuscular Blocking Agents; D001279:Atracurium; C101584:cisatracurium