title: Monitoring of neuromuscular block after administration of vecuronium in patients with diabetes mellitus.
abstract: BACKGROUND
  We studied the supramaximal current for ulnar nerve stimulation during electromyographic monitoring of onset and recovery of neuromuscular block using a neuromuscular transmission module (M-NMT Module, Datex-Ohmeda) in patients with Type 2 diabetes undergoing anaesthesia with nitrous oxide, oxygen, isoflurane and fentanyl.
  
  
  METHODS
  Thirty-six diabetic patients were randomly assigned to a post-tetanic count (PTC) group (n=17) or train-of-four (TOF) group (n=19). In addition, 30 non-diabetic patients were divided into control PTC (n=15) and TOF groups (n=15).
  
  
  RESULTS
  In the diabetic patients (diabetes PTC and diabetes TOF groups), the mean supramaximal stimulating current was significantly higher than in the non-diabetic patients (control PTC and TOF groups) (50.5 (SD 14.1) vs 33.4 (6.1) mA, P<0.01). Onset of neuromuscular block (time to disappearance of T1) after vecuronium 0.1 mg kg(-1) in the diabetic patients did not differ significantly from that in the non-diabetic patients (276 (77) vs 244 (44) s, P=0.055). Time to return of PTC1 did not differ significantly between the diabetes and control PTC groups (21.0 (12.1) vs 15.7 (5.0) min, P=0.126). Times to return of T1 and T4 in the diabetes TOF group were significantly longer than in the control TOF group (T1: 37.5 (15.2) vs 25.7 (7.6) min, P=0.01; T4: 61.4 (23.7) vs 43.5 (11.4) min, P=0.01). During recovery, PTC and T4/T1 in the diabetes PTC and TOF groups were similar to those in the control PTC and TOF groups, respectively. T1/T0 in the diabetes TOF group was significantly less than in the control TOF group, 80-120 min after vecuronium (P<0.05).
  
  
  CONCLUSIONS
  In diabetic patients, supramaximal current is higher than in non-diabetic patients. After vecuronium, onset of neuromuscular block and recovery of PTC or T4/T1 are not altered, but time to return of T1 or T4, and recovery of T1/T0 are delayed in diabetic patients.
authors.affiliation: Department of Anesthesiology, Fukushima Medical University School of Medicine, Hikarigaoka 1, Fukushima-City, Fukushima 960-1295, Japan. ys@m6.people.or.jp
authors.forename: Y
authors.initials: Y
authors.lastname: Saitoh
authors.forename: K
authors.initials: K
authors.lastname: Kaneda
authors.forename: H
authors.initials: H
authors.lastname: Hattori
authors.forename: H
authors.initials: H
authors.lastname: Nakajima
authors.forename: M
authors.initials: M
authors.lastname: Murakawa
mesh_terms: D000328:Adult; D000368:Aged; D000769:Anesthesia, Inhalation; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology*; D004558:Electric Stimulation / Q000379:methods; D004576:Electromyography / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D019148:Neuromuscular Blockade; D009469:Neuromuscular Junction / Q000187:drug effects* / Q000503:physiopathology; D003473:Neuromuscular Nondepolarizing Agents / Q000494:pharmacology*; D014673:Vecuronium Bromide / Q000494:pharmacology*
chemical_list: D003473:Neuromuscular Nondepolarizing Agents; D014673:Vecuronium Bromide