title: Timing of reversal with respect to three nerve stimulator end-points from cisatracurium-induced neuromuscular block.
abstract: After elective ear surgery with cisatracurium neuromuscular blockade, 48 adults were randomly assigned to receive neostigmine: (a) at appearance of the fourth twitch of a 'train-of-four'; (b) at loss of fade to train-of-four; or (c) at loss of fade to double-burst stimulation, all monitored using a TOF-Watch SX® on one arm. For each of these conditions, the recovery from train-of-four (TOF) ratio was measured in parallel objectively using a TOF-Watch SX placed on the contralateral arm. The median (IQR [range]) time from administration of reversal to a train-of-four ratio ≥ 0.9 was 11 (9-15.5 [2-28]) min, 8 (4-13.5 [1-25]) min and 7 (4-10 [2-15]) min in the three groups, respectively. This recovery time was significantly shorter when reversal was given at loss of fade to double-burst stimulation (c), than when given at the appearance of the fourth twitch (a), p = 0.046. However, the total time to extubation may be unaffected as it takes longer for fade to be lost after double-burst stimulation than for four twitches subjectively to appear.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: I A
authors.initials: IA
authors.lastname: Song
authors.affiliation: Department of Dental Anesthesiology, Seoul National University School of Dentistry, Seoul, Korea.
authors.forename: K S
authors.initials: KS
authors.lastname: Seo
authors.affiliation: Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: A Y
authors.initials: AY
authors.lastname: Oh
authors.affiliation: Department of Anesthesiology, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: H J
authors.initials: HJ
authors.lastname: No
authors.affiliation: Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: J W
authors.initials: JW
authors.lastname: Hwang
authors.affiliation: Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Y T
authors.initials: YT
authors.lastname: Jeon
authors.affiliation: Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: S H
authors.initials: SH
authors.lastname: Park
authors.affiliation: Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: S H
authors.initials: SH
authors.lastname: Do
mesh_terms: D000762:Anesthesia Recovery Period; D001279:Atracurium / Q000031:analogs & derivatives*; D002800:Cholinesterase Inhibitors / Q000008:administration & dosage; D004334:Drug Administration Schedule; D004423:Ear / Q000294:innervation / Q000601:surgery; D004558:Electric Stimulation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009388:Neostigmine / Q000008:administration & dosage*; D019148:Neuromuscular Blockade / Q000379:methods*; D009466:Neuromuscular Blocking Agents; D009469:Neuromuscular Junction / Q000187:drug effects; D013997:Time Factors
chemical_list: D002800:Cholinesterase Inhibitors; D009466:Neuromuscular Blocking Agents; D001279:Atracurium; D009388:Neostigmine; C101584:cisatracurium