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Titolo:
RELATIONSHIP OF THE TRAIN-OF-4 FADE RATIO TO CLINICAL SIGNS AND SYMPTOMS OF RESIDUAL PARALYSIS IN AWAKE VOLUNTEERS
Autore:
KOPMAN AF; YEE PS; NEUMAN GG;
Indirizzi:
ST VINCENTS HOSP & MED CTR,DEPT ANESTHESIOL,ROOM NR 408,153 W 11TH STNEW YORK NY 10011 NEW YORK MED COLL VALHALLA NY 10595
Titolo Testata:
Anesthesiology
fascicolo: 4, volume: 86, anno: 1997,
pagine: 765 - 771
SICI:
0003-3022(1997)86:4<765:ROTTFR>2.0.ZU;2-D
Fonte:
ISI
Lingua:
ENG
Soggetto:
ADDUCTOR POLLICIS MUSCLES; INTEGRATED EVOKED EMG; NEUROMUSCULAR BLOCKADE; PULMONARY-FUNCTION; SPONTANEOUS-RECOVERY; ORBICULARIS OCULI; HUMANS; ATRACURIUM; VECURONIUM; PANCURONIUM;
Keywords:
MONITORING, NEUROMUSCULAR FUNCTION, TRAIN-OF-4; NEUROMUSCULAR RELAXANTS, MIVACURIUM CHLORIDE; POSTOPERATIVE PERIOD, NEUROMUSCULAR RECOVERY, POSTANESTHESIA CARE UNIT, TESTING;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Citazioni:
28
Recensione:
Indirizzi per estratti:
Citazione:
A.F. Kopman et al., "RELATIONSHIP OF THE TRAIN-OF-4 FADE RATIO TO CLINICAL SIGNS AND SYMPTOMS OF RESIDUAL PARALYSIS IN AWAKE VOLUNTEERS", Anesthesiology, 86(4), 1997, pp. 765-771

Abstract

Background: Recovery of the train-of-four (TOF) ratio to a value >0.70 is synonymous with adequate return of neuromuscular function, but there is little information available concerning the subjective experience that accompanies residual neuromuscular block wherein the TOF ratiois in the range of 0.70 to 0.90.Methods: Ten American Society of Anesthesiologists' (ASA) physical status 1 volunteers were studied. Control measurements included grip strength in kilograms and ability to perform a 5-s head- and leg-lift In addition, a standard wooden tongue depressor was placed between each subject's incisor teeth, and he or she was told not to let the investigator remove it. All subjects were easily able to retain the device despite vigorous attempts to dislodge it. Neuromuscular function was monitored with a Date(TM) (Datex Medical Instrumentation Inc., Tewksbury, MA) 221 electromyographic (EMG) monitor. TOF stimulation was given every 20 s, and the measured TOF fade ratio was continuously recorded A 5 mg/kg bolus of mivacurium was then administered, and an infusion at 2 mg . kg(-1) . min(-1) was begun. The infusion was continued until the TOF ratio decreased to <0.70 and was adjusted to keep it in the range of 0.65 to 0.75. Signs and symptoms of weakness were recorded when the TOF ratio had been stable +/-0.03 for at least 10 min during an interval when there were no adjustments inthe infusion. All tests noted previously were repeated at this time. The TOF ratio was then allowed to recover to 0.85-0.90. when stable atthis level all tests were repeated, and the infusion was discontinued. TOF measurements were continued until a ratio of 1.0 was attained and until a final set of observations was recorded Results: The TOF ratio in all subjects was reduced to <0.70. No volunteers required intervention to maintain a patent ah-way, and the hemoglobin oxygen saturation while breathing air was greater than or equal to 96% at all times. TOF ratios less than or equal to 0.90 were accompanied by diplopia and difficulty in tracking moving objects in all subjects. The ability to strongly appose the incisor teeth did not return until the TOF ratio (on average) exceeded 0.85. A sustained 5-s head-lift was not achieved until the TOF ratio averaged 0.60 (range, 0.45-0.75). At a TOF ratio of 0.70, grip strength averaged 59% of control(range, 50-75%). With certain exceptions (vision, ability to clench the teeth tightly), there was wide variation in symptomatology between patients for any given TOFratio. It is impossible to give reliable TOF break-points at which symptoms and signs will be present or absent. Conclusions: All subjects had significant signs and symptoms of residual block at a TOF ratio of0.70; none considered themselves remotely ''street ready'' at this time. The authors believe that satisfactory recovery of neuromuscular function after mivacurium-induced neuromuscular block requires return ofthe TOF ratio to a value >0.90 and ideally to unity.

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Documento generato il 04/04/20 alle ore 01:16:23