title: Effects of partial neuromuscular blockade on facial nerve monitorization in otologic surgery.
abstract: OBJECTIVE
  Neuromuscular blockade (NMB) is administered as part of a general anesthetic in order to keep the patient immobilized during surgery and has been known to hinder intraoperative neuromonitorization. The aim of this study was to determine the effects of different levels of NMB on electrical stimulation thresholds of the facial nerve during otologic surgery.
  
  
  METHODS
  Intraoperative facial nerve monitorization was performed in 29 patients with advanced middle ear disease. Electromyographic (EMG) responses were recorded by insertion of needle electrodes into the orbicularis oris and orbicularis oculi muscles. Minimal facial nerve stimulations causing EMG responses in the facial musculature were measured during full recovery from the effects of muscular relaxants and with 25%, 50%, 75% and 100% levels of NMB. These defined NMB levels were maintained by the administration of a drip infusion of atracurium and were assessed objectively by recording the hypothenar muscle action.
  
  
  RESULTS
  All of the patients had detectable EMG responses of the facial musculature at the 50% and 75% levels of NMB in response to the electrical stimulation of the facial nerve. The corresponding mean stimulation thresholds were 0.10 +/- 0.08 and 0.11 +/- 0.09 mA, respectively. No responses were measured in 31% of the patients when the level of peripheral NMB was 100%.
  
  
  CONCLUSIONS
  This study suggests that a regulated 50% level of peripheral NMB provides reliable intraoperative EMG monitoring of the facial musculature in response to electrical stimulation and adequate anesthesia, with full immobilization of the patient.
authors.affiliation: Department of Otolaryngology, Inonu University Medical School, Turgut Ozal Medical Center, Malatya, Turkey. akizilay@inonu.edu.tr
authors.forename: Ahmet
authors.initials: A
authors.lastname: Kizilay
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Aladag
authors.forename: Yasar
authors.initials: Y
authors.lastname: Cokkeser
authors.forename: Murat Cem
authors.initials: MC
authors.lastname: Miman
authors.forename: Orhan
authors.initials: O
authors.lastname: Ozturan
authors.forename: Nurcin
authors.initials: N
authors.lastname: Gulhas
mesh_terms: D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D002648:Child; D004427:Ear Diseases / Q000175:diagnosis / Q000601:surgery*; D004432:Ear, Middle / Q000503:physiopathology / Q000601:surgery; D004576:Electromyography / Q000379:methods; D005152:Facial Muscles / Q000187:drug effects* / Q000502:physiology; D005154:Facial Nerve / Q000187:drug effects / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D009119:Muscle Contraction / Q000502:physiology; D019148:Neuromuscular Blockade / Q000379:methods*; D013506:Otologic Surgical Procedures / Q000379:methods*; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D016896:Treatment Outcome