Does repetition of post-tetanic count every 3 min during profound relaxation affect accelerographic recovery of atracurium blockade?
BACKGROUND
Post-tetanic count is a valuable method to assess profound neuromuscular blockade. However, subsequent responses to repetitive stimulation might be altered due to post tetanic facilitation (PTF). To avoid PTF, it has been advocated to limit the interval of stimulation from 6 to 10 min. The impact of PTF on 90% recovery of the TOF ratio has not been evaluated. Therefore, we assessed the effect of repetitive PTC stimulation on atracurium blockade with the primary outcome being the time to reach 90% TOF recovery in comparison to classical TOF stimulation.


METHODS
After informed consent 20 patients ASA I-II, scheduled for peripheral surgery under general anaesthesia and requiring tracheal intubation were enrolled into the study. Anaesthesia was induced with fentanyl, propofol, and atracurium, 0.5 mg kg(-1). Neuromuscular characteristics were assessed at the adductor pollicis by a TOF Watch((R)) accelerometer (Organon, Teknika, Holland) on each arm. After onset of maximum neuromuscular blockade, repetitive PTC every 3 min on one arm and repetitive TOF stimulation every 15 s on the opposite arm was performed. The following parameters were recorded: onset of maximum blockade, mean time of PTC stimulation, the maximum number of responses to PTC, time of the first and second TOF responses, and recovery profile until 90% TOF ratio.


RESULTS
Time to reach 90% TOF recovery was similar on both arms (48 +/- 9 min), with a difference of 16 +/- 38 s between the arms (P = 0.64). The first and second responses of the TOF on the PTC-stimulated arm appeared at 29 +/- 8 min and 33 +/- 7 min, respectively. On the other arm the responses appeared at 30 +/- 8 min and 35 +/- 8 min, respectively (P < 0.05).


CONCLUSIONS
Repetitive PTC stimulation every 3 min hastened the first and second responses of the TOF stimulation but we could not detect a significant difference in the 90% recovery of TOF ratio during atracurium blockade.
Motamed
C
C
Service d'Anaesthesie Réanimation Hôpital Henri Mondor, Créteil-APHP, Université Paris (12), Paris, France. motamed@igr.fr
Kirov
K
K
Combes
X
X
Duvaldestin
P
P
D000328:Adult; D000368:Aged; D000762:Anesthesia Recovery Period; D000768:Anesthesia, General; D001279:Atracurium; D004558:Electric Stimulation; D005260:Female; D006801:Humans; D007866:Leg / Q000601:surgery; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D009126:Muscle Relaxation / Q000187:drug effects*; D019148:Neuromuscular Blockade; D003473:Neuromuscular Nondepolarizing Agents; D010812:Physical Stimulation
D003473:Neuromuscular Nondepolarizing Agents; D001279:Atracurium