Clinical assessment of neuromuscular transmission.

Payne, J. P.; Hughes, R.

doi:10.1111/j.1365-2125.1981.tb01168.x

Cited by 10 publications

(1 citation statement)

References 48 publications

(28 reference statements)

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“…Other workers have reported that the first response of the train-of-four, regarded as a single twitch, recovered more rapidly than the fourth response and the train-of-four ratio (Bevan, 1979;Harper, Bradshaw and Healy, 1984;Jones, Pearce and Williams, 1984). Reliance on the return of the single twitch to the control value could be misleading, since a significant degree of residual receptor occupancy, as indicated by marked tetanic or train-of-four fade, may still be present (Ali et al, 1981;Payne and Hughes, 1981).…”

Section: Discussionmentioning

confidence: 99%

Antagonism of Atracurium-Induced Neuromuscular Blockade by Neostigmine or Edrophonium

Astley

Hughes

Payne

1986

British Journal of Anaesthesia

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Antagonism of atracurium-induced neuromuscular blockade by neostigmine or edrophonium has been studied using the tetanic (50 Hz) and train-of-four (2 Hz) or single twitch responses of the adductor pollicis muscle in 22 anaesthetized patients. A further nine patients not given an anticholinesterase acted as a control group. In two groups (six patients for each anticholinesterase) in whom antagonism was attempted at 95-98% blockade of the tetanic response, recovery of the tetanic response after two or three doses of edrophonium 0.75 mg kg-1 i.v. was not statistically different from that in the control group; recovery after two doses of neostigmine 2.5 mg i.v. was significantly faster (P less than 0.001). Recovery of the single twitch response after antagonism with edrophonium, although longer than that with neostigmine (P less than 0.01), was significantly shorter than in the control group (P less than 0.05). When edrophonium is given at the commencement of recovery, the initial rapid antagonism of tetanic block is not sustained, whereas antagonism by neostigmine is more persistent and the recovery phase is significantly shortened. In a further two groups of patients (n = 5) given atracurium 0.3 mg kg-1 i.v., antagonism was not attempted until the peak height of the tetanic contraction had reached approximately 50% of the control value.(ABSTRACT TRUNCATED AT 250 WORDS)

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Section: Discussionmentioning

confidence: 99%

Antagonism of Atracurium-Induced Neuromuscular Blockade by Neostigmine or Edrophonium

Astley

Hughes

Payne

1986

British Journal of Anaesthesia

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On the Comparative Sensitivity of Acetylcholine Receptors of Various Groups of Skeletal Muscles to Neuromuscular Blocking Agents

Харкевич¹,

Фисенко²

1986

New Neuromuscular Blocking Agents

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A bolus plus continuous infusion protocol for controlling neuromuscular blockade during anesthesia

Botman

Arps

Westenskow

1995

J Clin Monit Comput

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Neuromuscular blockade is controlled during anesthesia by administering either bolus doses or a continuous infusion of a blocking agent. To test whether a constant infusion technique requires less attention and provides better control we used a computer to simulate neuromuscular blockade. Using the model we maintained 95% blockade with mivacurium, atracurium, and vecuronium. It required 1.2 changes per hour to maintain the blockade by continuous infusion; an average of 4.5 bolus per hour were required to maintain blockade by the bolus technique. When the bolus and continuous infusion techniques were combined, only 0.16 changes per hour were required. Atracurium was then given to ten patients during anesthesia, following the bolus plus continuous infusion protocol. After a bolus was given to obtain 100% twitch depression, for tracheal intubation, neuromuscular function was assessed by train-of-four stimulation of the ulnar or facial nerves by observing the resultant muscle movement. When the first twitch of the train-of-four returned, relaxation was maintained by continuous infusion. A bolus was given and the drug infusion rate was changed whenever the level of relaxation changed from the desired one twitch of the train-of-four. The infusion rate was adjusted only 1.12 +/- 0.79 times per hour. The desired level of muscle relaxation was easily controlled using the bolus plus continuous infusion protocol. The infusion scheme might be implemented in future drug infusion pumps.

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Clinical assessment of neuromuscular transmission.

Cited by 10 publications

References 48 publications

Antagonism of Atracurium-Induced Neuromuscular Blockade by Neostigmine or Edrophonium

Antagonism of Atracurium-Induced Neuromuscular Blockade by Neostigmine or Edrophonium

On the Comparative Sensitivity of Acetylcholine Receptors of Various Groups of Skeletal Muscles to Neuromuscular Blocking Agents

A bolus plus continuous infusion protocol for controlling neuromuscular blockade during anesthesia

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