Positive and negative staircase effect during single twitch and train-of-four stimulation: a laboratory study in dogs

Martin‐Flores, Manuel; Tseng, Chia T.; Sakai, Daniel M.; Romano, Marta; Campoy, Luis; Gleed, Robin D.

doi:10.1007/s10877-016-9842-8

Cited by 4 publications

(1 citation statement)

References 12 publications

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“…This staircase phenomenon may introduce bias to T1 value measurements. However, in anesthetized dogs, the influence of the staircase phenomenon is minimal for the TOF ratio [30, 32]. Therefore, in the present study, the degree of neuromuscular blockade was evaluated using the TOF ratio.…”

Section: Discussionmentioning

confidence: 99%

Effect of sevoflurane anesthesia on neuromuscular blockade produced by rocuronium infusion in dogs

Sakata

Ishikawa

Ishihara³

et al. 2019

The Journal of Veterinary Medical Science

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This study evaluated the effect of sevoflurane anesthesia on neuromuscular blockade with rocuronium in dogs. Six healthy beagle dogs were anesthetized four times with a minimum 14-day washout period. On each occasion, the dogs were administered 1.25-, 1.5-, 1.75-, or 2.0-fold of the individualized minimum alveolar concentration (MAC) of sevoflurane and received an infusion of rocuronium (0.5 mg/kg followed by 0.2 mg/kg/hr) for 120 min. Neuromuscular function was monitored with acceleromyography and train-of-four (TOF) stimulation of the left hind limb. Time to achieve TOF count 0 (onset time), time from the onset of neuromuscular blockade to the reappearance of TOF count 4 (blockade period), and time from the onset of rocuronium infusion to attaining a 70 or 90% TOF ratio (TOFR 70 or TOFR 90 ) were recorded. There were no significant differences in the onset time, blockade period, and plasma rocuronium concentration between the sevoflurane MAC multiples. The TOFR 70 and TOFR 90 were dose-dependently prolonged with the sevoflurane MAC multiples. There were significant differences in the TOFR 70 and TOFR 90 between the 1.25 sevoflurane MAC (median: 55 and 77.5 min, respectively) and 1.75 sevoflurane MAC (122.0 and 122.6 min; P =0.020 and P =0.020, respectively), 1.25 sevoflurane MAC and 2.0 sevoflurane MAC (126.0 and 131.4 min; P =0.020 and P =0.020), and 1.5 sevoflurane MAC (97.5 and 121.3 min) and 2.0 sevoflurane MAC ( P =0.033 and P =0.032). In dogs, sevoflurane anesthesia produced dose-dependent prolongation of recovery from neuromuscular blockade produced by rocuronium.

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Section: Discussionmentioning

confidence: 99%

Effect of sevoflurane anesthesia on neuromuscular blockade produced by rocuronium infusion in dogs

Sakata

Ishikawa

Ishihara³

et al. 2019

The Journal of Veterinary Medical Science

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Journal of clinical monitoring and computing 2017 end of year summary: anesthesia

Hendrickx

Wolf

Skinner

2018

J Clin Monit Comput

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Influence of tetanic stimulation on the staircase phenomenon and the acceleromyographic time-course of neuromuscular block: a randomized controlled trial

Mazzinari

Errando

Díaz‐Cambronero

et al. 2018

J Clin Monit Comput

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During neuromuscular monitoring, repeated electrical stimulation evokes muscle responses of increasing magnitude ('staircase phenomenon', SP). We aimed to evaluate whether SP affects time course and twitches' values of an acceleromyographic assessed neuromuscular block with or without previous tetanic stimulation. Fifty adult patients were randomized to receive a 50 Hz tetanic stimulus (S group) or not (C group) before monitor calibration. After 20 min of TOF ratio (TOFr) stimulation rocuronium was administered. Onset time of block (primary endpoint), recovery of T1 to 25%, TOFr to 0.9, and recovery index were compared. We also compared T1 and TOFr at baseline, post-stimulation, and during recovery from block. Moreover the correlation between T1 at maximum recovery and (a) baseline T1 and (b) post-stimulation T1 along with T1/TOFr ratio during recovery were evaluated. After stimulation median T1 increased (32%) in group C and decreased (16%) in group S (P = 0.0001). Onset time (Median [IQR] in seconds) was 90 (29-77) vs. 75 (28-60) in C and S group (P = 0.002). Time [Mean (SD) in minutes] to normalized TOFr 0.9 were 70.13 (14.9) vs. 62.1 (21.2) in C and S groups (P = 0.204). TOFr showed no differences between groups at any time point. T1 at maximum recovery showed a stronger correlation with post-stabilization T1 compared to baseline. (ρ = 0.80 and ρ = 0.85, for C and S groups.) Standard calibration does not ensure twitch baseline stabilization and prolongs onset time of neuromuscular block. TOF ratio is not influenced by SP.

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Positive and negative staircase effect during single twitch and train-of-four stimulation: a laboratory study in dogs

Cited by 4 publications

References 12 publications

Effect of sevoflurane anesthesia on neuromuscular blockade produced by rocuronium infusion in dogs

Effect of sevoflurane anesthesia on neuromuscular blockade produced by rocuronium infusion in dogs

Journal of clinical monitoring and computing 2017 end of year summary: anesthesia

Influence of tetanic stimulation on the staircase phenomenon and the acceleromyographic time-course of neuromuscular block: a randomized controlled trial

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