The Duration of Residual Neuromuscular Block After Administration of Neostigmine or Sugammadex at Two Visible Twitches During Train-of-Four Monitoring

2011 ◽  
Vol 112 (1) ◽  
pp. 63-68 ◽  
Author(s):  
Hanna L. Illman ◽  
Päivi Laurila ◽  
Heikki Antila ◽  
Olli A. Meretoja ◽  
Seppo Alahuhta ◽  
...  
Keyword(s):  
Neuromuscular Block ◽  
Train Of Four ◽  
Train Of Four Monitoring ◽  
Residual Neuromuscular Block

The Duration of Residual Neuromuscular Block After Administration of Neostigmine or Sugammadex at Two Visible Twitches During Train-of-Four Monitoring

2011 ◽  
Vol 55 (6) ◽  
pp. 304-305
Author(s):  
Hanna L. Illman ◽  
Päivi Laurila ◽  
Heikki Antila ◽  
Olli A. Meretoja ◽  
Seppo Alahuhta ◽  
...  
Keyword(s):  
Neuromuscular Block ◽  
Train Of Four ◽  
Train Of Four Monitoring ◽  
Residual Neuromuscular Block

Residual Block after Mivacurium with or without Edrophonium Reversal in Adults and Children

1996 ◽  
Vol 84 (2) ◽  
pp. 362-367. ◽  
Author(s):  
David R. Bevan ◽  
Raymond Kahwaji ◽  
John M. Ansermino ◽  
Eleanor Reimer ◽  
Michael F. Smith ◽  
...  
Keyword(s):  
Ulnar Nerve ◽  
Neuromuscular Block ◽  
Saline Group ◽  
Neuromuscular Blocking ◽  
Postanesthesia Care Unit ◽  
Random Allocation ◽  
Train Of Four ◽  
Residual Neuromuscular Block ◽  
Residual Block ◽  
Stimulation Of

Background The rapid recovery from mivacurium- induced neuromuscular block has encouraged omission of its reversal. The purpose of this study was to determine, in children and in adults, whether failure to reverse mivacurium neuromuscular block was associated with residual neuromuscular block on arrival in the postanesthesia care unit. Methods In 50 children, aged 2-12 yr, and 50 adults, aged 20-60 yr, anesthesia was induced and maintained with propofol and fentanyl, and neuromuscular block was achieved by an infusion of mivacurium, to maintain one or two visible responses to train-of-four (TOF) stimulation of the ulnar nerve. At the end of surgery, mivacurium infusion was stopped, and 10 min later, reversal was attempted with saline or 0.5 mg x kg(-1) edrophonium by random allocation. On arrival in the postanesthesia care unit, a blinded observer assessed patients clinically and by stimulation of the ulnar nerve with a Datex electromyogram in the uncalibrated TOF mode. Results Children arrived in the postanesthesia care unit 8.2 +/- 3-4 min after reversal of neuromuscular block and showed no sign of weakness, either clinically or by TOF stimulation. Although TOF ratio was greater in children who had received edrophonium (1.00 +/- 0.05 vs. 0.93 +/- 0.01, P<0.01), TOF was >0.7 in all children. Adults arrived in the postanesthesia care unit 12.9 +/- 5.3 min after reversal of neuromuscular block(P<0.01 vs. children). Six in the saline group demonstrated weakness (two required immediate reversal of neuromuscular block, and TOF was <0.7 in four others), compared with TOF <0.7 in only one of the edrophonium group (P<0.05). Conclusions This study demonstrated that, in adults, failure to reverse mivacurium neuromuscular block was associated with an increased incidence of residual block. Such weakness was not observed in children receiving similar anesthetic and neuromuscular blocking regimens.

The train-of-four or double-burst ratios cannot reliably exclude residual neuromuscular block in cats

2020 ◽  
Vol 133 ◽  
pp. 131-135
Author(s):  
D.M. Sakai ◽  
C.T. Tseng ◽  
E.A. Militana ◽  
M. Martin-Flores
Keyword(s):  
Neuromuscular Block ◽  
Train Of Four ◽  
Residual Neuromuscular Block

scholarly journals Low-frequency Neuromuscular Depression Is a Consequence of a Reduction in Nerve Terminal Ca2+ Currents at Mammalian Motor Nerve Endings

2013 ◽  
Vol 119 (2) ◽  
pp. 326-334
Author(s):  
Eugene M. Silinsky
Keyword(s):  
Nerve Terminal ◽  
Nerve Stimulation ◽  
Neurotransmitter Release ◽  
Neuromuscular Junctions ◽  
Motor Nerve ◽  
Neuromuscular Block ◽  
Low Frequency ◽  
Neuromuscular Blocking ◽  
Train Of Four ◽  
Train Of Four Monitoring

Abstract Background: The decline in voluntary muscle contraction during low-frequency nerve stimulation is used clinically to assess the type and degree of neuromuscular block. The mechanism underlying this depression is unknown. Methods: Simultaneous electrophysiological measurements of neurotransmitter release and prejunctional Ca2+ currents were made at mouse neuromuscular junctions to evaluate the hypothesis that decreases in nerve terminal Ca2+ currents are responsible for low-frequency depression. Results: Under conditions generally used to measure Ca2+ currents at the neuromuscular junction, increasing the frequency of nerve stimulation briefly from 0.017 to 0.1–1 Hz caused a simultaneous reduction in the release of the neurotransmitter acetylcholine to 52.2 ± 4.4% of control and the Ca2+ current peak to 75.4 ± 2.0% of control (P < 0.001, n = 5 experiments for both measurements, mean ± SEM for all data). In conditions used for train-of-four monitoring (4 stimuli, 2 Hz), neurotransmitter release declined to 42.0 ± 1.0% of control and the Ca2+ current peak declined to 75.8 ± 3.3% of control between the first and fourth stimulus (P < 0.001, n = 7 experiments for both measurements). Depression in acetylcholine release during train-of-four protocols also occurred in the absence of neuromuscular-blocking drugs. Discussion: The results demonstrate that neuromuscular depression during train-of-four monitoring is due to a decline in nerve terminal Ca2+ currents, hence reducing the release of acetylcholine. As similar processes may come into play at higher stimulation frequencies, agents that antagonize the decline in Ca2+ currents could be used to treat conditions in which neuromuscular depression can be debilitating.

Sign in / Sign up

Export Citation Format

Share Document