Relationship of the Train-of-Four Fade Ratio to Clinical Signs and Symptoms of Residual Paralysis in Awake Volunteers

SummaryReversal of vecuronium-induced neuromuscular blockade with neostigmine was compared in two groups of 16 subjects: patients with Type 2 diabetes mellitus and normal controls. When the first twitch of the train-of-four had returned to 25% of the control value, neostigmine 40 lg.kg )1 and atropine 20 lg.kg )1 were given to reverse the neuromuscular blockade. The train-of-four ratio was lower at 3 min, 6 min, 9 min, 12 min and 15 min after reversal in the diabetic group than in the control group but the differences did not reach statistical significance. Fifteen minutes after reversal, the number of patients in whom recovery from neuromuscular blockade was judged insufficient to guarantee good respiratory function (train-of-four ratio < 0.74) did not differ between the groups. However, 15 min after reversal, the number of patients with a train-of-four ratio < 0.9 was significantly higher in the Diabetic Group than in the Control Group (15 vs. 10, p = 0.033).

Section: Methodsmentioning

confidence: 99%

Retracted: Reversal of vecuronium with neostigmine in patients with diabetes mellitus

Saitoh

Hattori²,

Sanbe³

et al. 2004

“…However, we used as the endpoint a TOF ratio of 0.8 in line with recent recommendations [12]. It has been suggested that lower TOF ratios may be associated with signs of subjective weakness [13].…”

mentioning

confidence: 99%

Dosage of neostigmine for reversal of rocuronium block from two levels of spontaneous recovery

McCourt¹,

Mirakhur

Kerr

1999

SummarySpontaneous recovery, and recovery following neostigmine 20, 35 or 50 mg.kg ¹1 administered at 10 or 25% of recovery of the first twitch of the train-of-four, was assessed in 80 patients after rocuronium administration under continued isoflurane anaesthesia. In an additional 40 patients, isoflurane administration was discontinued and neostigmine 35 or 50 mg.kg ¹1 was given at 10 or 25% recovery. The administration of neostigmine reduced the recovery times significantly. A neostigmine dose of 20 mg.kg ¹1 resulted in slower recovery compared with the higher doses, particularly when reversal was attempted at a first twitch height of 10%. Higher doses of neostigmine given at a first twitch height of 25% resulted in rapid reversal of block [mean (SD) times of 7.0 (4.8) and 6.4 (1.9) min with the 35 and 50 mg.kg ¹1 doses, respectively, for attaining a train-of-four ratio of 0.8]. Discontinuing isoflurane did not alter recovery times. The incidence of emetic symptoms did not differ between groups, including one group that received atropine instead of glycopyrronium in combination with neostigmine. We conclude that rocuronium block can be antagonised safely using a neostigmine dose of 35 mg.kg ¹1 , although recovery may be slightly slower if administered at a first twitch of 10% of control.

“…The median (IQR [range]) times from administration of the reversal agents to a TOF ratio of 0.9 in the TOF4, TOF-fade and DBS-fade groups was 11 (9-15.5 ) min, 8 (4-13.5 ) min and 7 (4-10 [2][3][4][5][6][7][8][9][10][11][12][13][14][15]) min, respectively. The reversal time to a TOF ratio of 0.7 and 0.8 was shorter in the TOF-fade and DBS-fade groups than in the TOF4 group (p = 0.001 and 0.0013, respectively) and the time to a TOF ratio of 0.9 was shorter in the DBS-fade group than in the TOF4 group (p = 0.046) (Fig.…”

Section: Resultsmentioning

confidence: 99%

Timing of reversal with respect to three nerve stimulator end-points from cisatracurium-induced neuromuscular block

Song

Seo

et al. 2015

SummaryAfter elective ear surgery with cisatracurium neuromuscular blockade, 48 adults were randomly assigned to receive neostigmine: (a) at appearance of the fourth twitch of a 'train-of-four'; (b) at loss of fade to train-of-four; or (c) at loss of fade to double-burst stimulation, all monitored using a TOF-Watch SX â on one arm. For each of these conditions, the recovery from train-of-four (TOF) ratio was measured in parallel objectively using a TOF-Watch SX placed on the contralateral arm. The median (IQR [range]) time from administration of reversal to a train-of-four ratio ≥ 0.9 was 11 (9-15.5 [2-28]) min, 8 (4-13.5 [1-25]) min and 7 (4-10 [2-15]) min in the three groups, respectively. This recovery time was significantly shorter when reversal was given at loss of fade to double-burst stimulation (c), than when given at the appearance of the fourth twitch (a), p = 0.046. However, the total time to extubation may be unaffected as it takes longer for fade to be lost after double-burst stimulation than for four twitches subjectively to appear.