Potency of Pancuronium at the Diaphragm and the Adductor Pollicis Muscle in Humans

Donati, François; Antzaka, Christina; Dr, Bevan

doi:10.1097/00000542-198607000-00001

Cited by 121 publications

(37 citation statements)

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“…13,[41][42][43] The conventional site for electromyographic recording has been the seventh or eighth intercostal space (Figure 5a), between the anterior axillary and the mid-clavicular line. 41 A novel site at the patient's back has been used recently to monitor neuromuscular block at the diaphragm 44 ( Figure 5b) and has shown good agreement with im needle electromyography of the diaphragm. 44 Both sites of electromyographic diaphragm recording can be used after unilateral phrenic nerve stimulation.…”

Section: Monitoring Neuromuscular Blockade At the Diaphragmmentioning

confidence: 99%

“…Furthermore, earlier studies did not provide the full pharmacodynamic profile, but concentrated on the determination of the potency of several muscle relaxants at the diaphragm. 41,45,47,50 Similar to the larynx, a given dose of NMBA creates less peak effect at the diaphragm than at the adductor pollicis muscle. Doses greater than the ED 95 create more than 80% block at the diaphragm.…”

Section: Differences Between Neuromuscular Blockade At the Diaphragm mentioning

confidence: 99%

“…41,52,53 This diaphragm-sparing effect of NMBA can be explained by a higher acetylcholine receptor density, a higher acetylcholine release or lower acetylcholinesterase activity 54,55 in the diaphragm. 25 The small fibre size and the large endplates, relative to fibre size, of the diaphragm might contribute to the shorter duration of neuromuscular block.…”

Section: Neurophysiologic Basis For the Pharmacodynamic Differences Bmentioning

confidence: 99%

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Neuromuscular blockade at the larynx, the diaphragm and the corrugator supercilii muscle: a review

Hemmerling

Donati

2003

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : To review recent findings concerning neuromuscular blockade and monitoring at the larynx, the diaphragm, and the corrugator supercilii muscle.S So ou ur rc ce e: : This narrative review is based on recent publications. P Pr ri in nc ci ip pa al l f fi in nd di in ng gs s: : Neuromuscular blockade at the larynx and the diaphragm is less intense than at the adductor pollicis muscle; the onset and offset of neuromuscular blockade is more rapid. The corrugator supercilii muscle reflects better the time course of neuromuscular blockade of the larynx than the adductor pollicis muscle, is better suited to monitor the onset of neuromuscular blockade for intubation, and should give a better reflection of the time course and degree of neuromuscular blockade of the larynx or the diaphragm. Recovery of neuromuscular function at the end of any procedure is best reflected at the adductor pollicis muscle where neuromuscular transmission is last restored. Clinical monitoring of the larynx or the diaphragm is still limited by the absence of a simple method. Acceleromyography of the corrugator supercilii muscle is prone to artifacts that do not occur during monitoring of the adductor pollicis muscle. Phonomyography, a new method of monitoring that is currently being tested, is based on the phenomenon that muscle contraction creates low-frequency sound waves, which can be detected using special microphones to quantify neuromuscular blockade. This method seems promising because it can be easily used on all muscles of interest.C Co on nc cl lu us si io on n: : Research during the last 15 years has greatly enhanced our knowledge about how muscles react differently to muscle relaxants and has enabled us to achieve better surgical conditions with safer use of muscle relaxants. Interesting technologies have been developed to reliably monitor neuromuscular blockade at the larynx and the diaphragm, but are currently restricted to research settings. Our increased understanding should help us in ongoing efforts to develop the "ideal" muscle relaxant and the "ideal" method of neuromuscular monitoring. Objectif

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Section: Monitoring Neuromuscular Blockade At the Diaphragmmentioning

confidence: 99%

Section: Differences Between Neuromuscular Blockade At the Diaphragm mentioning

confidence: 99%

Section: Neurophysiologic Basis For the Pharmacodynamic Differences Bmentioning

confidence: 99%

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Neuromuscular blockade at the larynx, the diaphragm and the corrugator supercilii muscle: a review

Hemmerling

Donati

2003

Can J Anesth/J Can Anesth

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“…In general, however, the more centrally located muscles, such as those of the face and respiration, are relatively resistant to the effects of neuromuscular blocking agents. 1 With doses of nondepolarizing neuromuscular blocking agents that cause 100% neuromuscular block at the adductor pollicis (AP), the larynx does not necessarily develop that depth of block, 2 neither does the diaphragm. 1,3,4 The more centrally located muscles also have a faster onset of and recovery from neuromuscular blockade than those that are located more peripherally.…”

mentioning

confidence: 99%

Edrophonium effectively antagonizes neuromuscular block at the laryngeal adductors induced by rapacuronium, rocuronium and cisatracurium, but not mivacurium

Suzuki

Lien

Belmont

et al. 2003

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : To examine the efficacy of antagonism of rapacuronium-, mivacurium-, rocuronium-and cisatracurium-induced neuromuscular block at the laryngeal adductors (LA). M Me et th ho od ds s: :One hundred four patients were randomly assigned to one of eight study groups. They either received rapacuronium 1.5 mg·kg ) at 10% recovery of the first twitch (T1) of train-of-four (TOF) at the LA or were allowed to recover spontaneously from neuromuscular block. The effect of antagonism on speed of recovery of neuromuscular function at the LA was evaluated.R Re es su ul lt ts s: : The time to recovery to a TOF ratio of 0.9 at the LA, when compared to the spontaneous recovery group, was significantly shortened by the administration of edrophonium in patients receiving rapacuronium [19.2 ± 7.8 vs 26.2 ± 4.9 (mean ± SD) min], rocuronium (24.7 ± 14.3 vs 44.4 ± 13.0 min) and cisatracurium (24.2 ± 5.7 vs 35.1 ± 7.6 min). Edrophonium administration did not shorten complete recovery from mivacurium-induced block (15.7 ± 8.0 vs 17.6 ± 6.1 min).C Co on nc cl lu us si io on n: : Recovery from rapacuronium-, rocuronium-or cisatracurium-induced neuromuscular block to a TOF ratio of 0.9 as measured at the LA was shortened by the administration of edrophonium, when compared to spontaneous recovery. [19,2 ± 7,8 vs 26,2 ± 4,9 (moyenne ± écart type) min], le rocuronium (24,7 ± 14,3 vs 44,4 ± 13,0 min) et le cisatracurium (24,2 ± 5,7 vs 35,1 ± 7,6 min). L'administration d'édrophonium n'a pas raccourci le temps de récupération complète d'un bloc induit par le mivacurium (15,7 ± 8,0 vs 17,6 ± 6,1 min Objectif

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“…However, they do lend further support to our contention that the OOM electromyography may not be a reliable indicator of the integrity of neuromuscular transmission as its recovery preceded ADM recovery in all cases. As well, observations made by Laycock et al 25 and Donati et al 26 that the diaphragm is more resistant to neuromuscular blockade than the thenar muscles suggest that this important respiratory muscle would also recover earlier than the thenar muscles. It is therefore probable that the recovery of OOM EMG may parallel that of the diaphragm and indicate at least the onset of recovery of respiratory function.…”

Section: Discussionmentioning

confidence: 76%

Comparison of integrated evoked EMG between the hypothenar and facial muscle groups following atracurium and vecuronium administration

et al. 1991

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In 17 healthy patients undergoing 02" N20' isoflurane anaesthesia, following atracurium or vecuronium administration, we compared simultaneous integrated evoked electromyograms (IEEMGs) (33,4 • 5 vs 46,5 • 8 min, P < 0,005)et avec le vEcuronium (46,(5)(6)(7)(8)(9)(10)(11)(12)3 • 20 min, P < 0,005). Quand le T4/TI de I'ORB atteignaitO, 7 • O, 1, celui de rADD n'Etait que de 0,15 (P < 0,05) Nous avons compare les traces dlectromyographiques int~SgrEs de l'orbiculaire des paupiOres (ORB) et de I'adducteur du petit doigt (ADD) dvoquEs simultanEment par stimulation en train-de-quatre des nerfs facial et cubital; cela, pendant I'anesthEsie avec 02, NzO et isoflurane de 17 sujets sains aprEs injection d'atracurium ou de vEcuronium. Chez tousles patients, la recuperation de la fonction neuromusculaire survenait d'abord d I'ORB. Le temps requis pour retrouver un ratio de T4/TI +-0,7 +-O, I (Ecart-type) Eta#plus court pour I'ORB que pour I'ADD, ~ la fois avec I'atracurium

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Potency of Pancuronium at the Diaphragm and the Adductor Pollicis Muscle in Humans

Cited by 121 publications

References 0 publications

Neuromuscular blockade at the larynx, the diaphragm and the corrugator supercilii muscle: a review

Neuromuscular blockade at the larynx, the diaphragm and the corrugator supercilii muscle: a review

Edrophonium effectively antagonizes neuromuscular block at the laryngeal adductors induced by rapacuronium, rocuronium and cisatracurium, but not mivacurium

Comparison of integrated evoked EMG between the hypothenar and facial muscle groups following atracurium and vecuronium administration

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