title: A priming technique accelerates onset of neuromuscular blockade at the laryngeal adductor muscles.
abstract: OBJECTIVE
  Priming is a known technique to accelerate onset of neuromuscular blockade (NMB). Its effect on NMB of the larynx has not been studied yet.
  
  
  METHODS
  We compared a priming technique with a bolus application of rocuronium on the onset of NMB at the laryngeal adductor and the adductor pollicis muscles (AP). In 30 female patients, after induction of anesthesia a tube with a surface electrode was placed into the trachea prior to the administration of any neuromuscular blocking agent to monitor electromyography (EMG) of the laryngeal adductor muscles. Neuromuscular monitoring consisted of EMG of the laryngeal adductor muscles and the left AP. Patients were randomized into two groups. After transcutaneous stimulation of the recurrent laryngeal nerve and ulnar nerve, a bolus of rocuronium 0.6 mg x kg(-1) (Bolus group) or a priming dose of rocuronium 0.06 mg x kg(-1) followed by rocuronium 0.54 mg x kg(-1) three minutes later (Priming group) were injected. Lag time, onset 90%, onset time and peak effect of NMB were recorded and compared; a P < 0.05 was considered significant.
  
  
  RESULTS
  The onset 90% and onset time measured at the laryngeal adductor muscles (onset: 44.7 +/- 7.4 vs 74.0 +/- 23.8 sec) and at the AP (onset: 105.4 +/- 29.9 vs 139.2 +/- 51.5 sec) were significantly shorter in the Priming group than in the Bolus group. Within groups, the onset times were significantly shorter at the laryngeal muscles in comparison to AP.
  
  
  CONCLUSIONS
  Our results indicate that a priming technique with rocuronium significantly accelerates the onset of NMB at the laryngeal adductor muscles. Our results further support the use of rocuronium as an alternative to succinylcholine for rapid sequence induction.
authors.affiliation: Department of Anesthesiology, University of Erlangen-Nuremberg, Krankenhausstr. 12, D-91054 Erlangen, Germany. joachim.schmidt@gmx.ch
authors.forename: Joachim
authors.initials: J
authors.lastname: Schmidt
authors.forename: Andrea
authors.initials: A
authors.lastname: Irouschek
authors.forename: Tino
authors.initials: T
authors.lastname: Muenster
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Hemmerling
authors.forename: Sven
authors.initials: S
authors.lastname: Albrecht
mesh_terms: D000328:Adult; D000732:Androstanols / Q000008:administration & dosage; D000758:Anesthesia; D004558:Electric Stimulation; D004576:Electromyography; D005260:Female; D006801:Humans; D007821:Laryngeal Muscles / Q000187:drug effects*; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage; D012009:Recurrent Laryngeal Nerve / Q000502:physiology; D000077123:Rocuronium; D009435:Synaptic Transmission / Q000187:drug effects; D013961:Thyroid Gland / Q000601:surgery
chemical_list: D000732:Androstanols; D003473:Neuromuscular Nondepolarizing Agents; D000077123:Rocuronium