Post-tetanic count at adductor pollicis is a better indicator of early diaphragmatic recovery than train-of-four count at corrugator supercilii.
BACKGROUND
Because the intensity of neuromuscular block at the diaphragm (DIA) is indirectly assessed, the electromyographic measurements of the DIA (DIA(EMG)) from surface electrodes were related to information provided by visual estimation of neuromuscular transmission at the adductor pollicis (AP) and the corrugator supercilii (CSC) during recovery from vecuronium block.


METHODS
Twelve adult patients were studied during balanced anaesthesia. After induction of anaesthesia and tracheal intubation without neuromuscular blocking agent, supramaximal stimulations were applied to phrenic, ulnar and facial nerves. During recovery from vecuronium 0.1 mg kg(-1) an independent observer blinded to DIA(EMG) counted visually detectable train-of-four (TOF) at CSC (TOF(CSC)) and post-tetanic AP (PTC(AP)) responses. Times to recovery of PTC(AP) = 1, <or=5, <10 and >10, and TOF(CSC) = 1-4 responses were related to DIA(EMG). Values are means (sd).


RESULTS
Reappearance of the first response to PTC(AP) occurred significantly (P < 0.05) earlier and for a lower recovery of DIA(EMG) than that of TOF(CSC) [24 (8) min vs 33 (9) min, and 10 (10)% vs 25 (8)%, respectively]. With PTC(AP) <or= 5 response, DIA(EMG) recovery was 21 (11)%. Recovery of TOF(CSC) = 1 and 2 coincided with DIA(EMG) recovery of 25 (8)% and 47 (9)%, respectively.


CONCLUSIONS
PTC(AP) may better reflect early recovery of vecuronium-induced DIA paralysis than TOF(CSC). The findings suggested that PTC(AP) <or= 5 warranted deep neuromuscular block of the DIA.
Dhonneur
G
G
Anaesthesia and Intensive Care Department, Jean Verdier University Hospital of Paris, 93143 Bondy Cedex, France. gilles.dhonneur@jvr.aphp.fr
Kirov
K
K
Motamed
C
C
Amathieu
R
R
Kamoun
W
W
Slavov
V
V
Ndoko
S-K
SK
D000328:Adult; D000368:Aged; D000762:Anesthesia Recovery Period; D003964:Diaphragm / Q000187:drug effects* / Q000502:physiology; D004558:Electric Stimulation / Q000379:methods; D004576:Electromyography / Q000187:drug effects; D005152:Facial Muscles / Q000187:drug effects / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D018482:Muscle, Skeletal / Q000187:drug effects* / Q000502:physiology; D019148:Neuromuscular Blockade; D009469:Neuromuscular Junction / Q000187:drug effects; D003473:Neuromuscular Nondepolarizing Agents / Q000494:pharmacology*; D011182:Postoperative Care / Q000379:methods; D016037:Single-Blind Method; D014673:Vecuronium Bromide / Q000494:pharmacology*
D003473:Neuromuscular Nondepolarizing Agents; D014673:Vecuronium Bromide