ISSN:
1573-2614
Keywords:
Anesthetic techniques
;
Measurement techniques: electromyography; neuromuscular blockade
;
Monitoring: neuromuscular blockade
;
Neuromuscular relaxants: succinylcholine; pancuronium; vecuronium; atracurium
Source:
Springer Online Journal Archives 1860-2000
Topics:
Computer Science
,
Medicine
Notes:
Abstract Facial and hand muscles are used frequently for monitoring neuromuscular blockade. Therefore, we compared changes in electrically evoked muscle potential magnitude in upper facial and hypothenar muscles after fixed doses of neuromuscular blockers (succinylcholine, 750 µg/kg; pancuronium, 70 µg/kg; vecuronium, 50 µg/kg; and atracurium, 300 µg/kg). Face-hand comparisons were made in both anesthetized (nitrous oxide/narcotic, n=51) and comatose (closed-head injuries, n=5) patients. In 24 anesthetized patients, complete blockade of the hypothenar muscles prevented quantitative comparison. In the remaining 27 patients, the relaxant effect (as determined by the percentage change from prerelaxant baseline muscle potentials) was significantly smaller (P〈0.0001) in the upper facial muscles (65±24% versus 92±8%, mean ±SD). All four evoked muscle responses to train-of-four stimulation were detectable in upper facial muscles of the 19 patients receiving non-depolarizing neuromuscular blocking drugs; this pattern was seen in hand muscles of only 7 patients (P〈0.001). The neuromuscular blockade in both the hand (49±54%) and the upper facial area (68±28%,P〉0.05) of comatose patients was smaller and more variable than that seen during anesthesia. These results illustrate the valuc of quantitative monitoring of neuromuscular function, especially during highly variable and unpredictable drug-induced blockade in the comatose state. We conclude that during narcotic-based anesthesia the upper facial and hand muscles are differentially sensitive to commonly used neuromuscular blockers.
Type of Medium:
Electronic Resource
URL:
http://dx.doi.org/10.1007/BF01617322
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