Train–of–four fade during onset of neuromuscular block with nondepolarising neuromuscular blocking agents

Gibson, F. M.; Mirakhur, R. K.

doi:10.1111/j.1399-6576.1989.tb02890.x

Cited by 20 publications

(18 citation statements)

References 13 publications

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“…It appears that the relaxants used in the present study do not show the same extent of differences in their relative prejunctional effects as are present between pancuronium and tubocurarine [7]. It has been suggested that the extent of fade may be related to potency Anaesthesia, 1998 ............................................................................................................................................................................................................................................ [11] but this is not supported by the findings of the present study where drugs with considerably different potencies such as rocuronium, vecuronium and mivacurium showed similar degrees of fade.…”

Section: Discussionmentioning

confidence: 45%

“…Similarly greater fade was demonstrated with tubocurarine compared to pancuronium when a TOF mode of stimulation was used [7]. It is clear from previous studies that differences in fade between relaxants are most obvious during the onset of block with little difference during recovery [6,7].…”

Section: Discussionmentioning

confidence: 81%

“…It is suggested that fade may be an expression of prejunctional binding, impairing transmitter mobilisation during rapid stimulation [4,8,9]. Although the prejunctional effect of nondepolarising muscle relaxants is classically demonstrated by applying tetanic stimulation, similar results have been demonstrated by applying TOF stimulation also [6,7,10].…”

Section: Discussionmentioning

confidence: 87%

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Neuromuscular blocking effects and train‐of‐four fade with cisatracurium: comparison with other nondepolarising relaxants

et al. 1998

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SummaryNeuromuscular blocking drugs exhibit different degrees of fade in response to train-of-four stimulation believed to represent their relative prejunctional effects. The present study was designed to compare the train-of-four fade after cisatracurium and compare this with other commonly used muscle relaxants. Train-of-four fade during onset and recovery of block were recorded after administration of cisatracurium 0.05 or 0.1 mg.kg ¹1 , atracurium 0.5 mg.kg ¹1 , vecuronium 0.08 mg.kg ¹1 , mivacurium 0.15 mg.kg ¹1 or rocuronium 0.6 mg.kg ¹1 to patients anaesthetised with fentanyl, nitrous oxide and a propofol infusion. Neuromuscular monitoring was by stimulation of the ulnar nerve and recording the force of contraction of the adductor pollicis muscle. The onset and recovery of block were also measured. Train-of-four fade during onset of block was greater with the lower dose of cisatracurium compared with the higher dose of cisatracurium and all other relaxants. Train-of-four fade during recovery was similar. The median times (and ranges) for the onset of maximum block were 3.4 (2.1-5.6), 1.5 (1.2-2.3), 2.1 (1.2-2.6), 2.0 (1.5-2.7) and 1.0 (0.7-1.3) min for cisatracurium 0.1 mg.kg ¹1 and atracurium, mivacurium, vecuronium and rocuronium, respectively. The median times (and ranges) for the recovery of T 1 to 25% of control and to a train-of-four ratio of 0.8 were 41 (21-50) and 65 (40-78); 43 (37-54) and 69 (58-79); 15 (11-20) and 25 (19-30); 31 (23-46) and 60 (45-117); and 33 (18-57) and 50 (28-76) min following cisatracurium, 0.1 mg.kg ¹1 , atracurium, mivacurium, vecuronium and recuronium, respectively.

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Section: Discussionmentioning

confidence: 45%

Section: Discussionmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 87%

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Neuromuscular blocking effects and train‐of‐four fade with cisatracurium: comparison with other nondepolarising relaxants

et al. 1998

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“…The mechanisms underlying the various TOF fade have not yet been fully elucidated. Careful survey of the reported data [3][4][5], however, indicated the existence of regularity: the degree of TOF fade is almost inversely related to the potencies of the drugs. TOF fade is a clinical index of the depth of neuromuscular blockade produced by the drugs.…”

Section: Introductionmentioning

confidence: 97%

“…Nondepolarizing neuromuscular blocking drugs, however, induce fade in the series of four twitch heights as well as the depression of T1. The TOF ratio (T4/T1) at a certain degree of T1 depression varies depending on the drugs [3][4][5]. It has been considered that the difference of TOF fade among the drugs is due to the presynaptic action of the drugs [8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Difference of train-of-four fade induced by nondepolarizing neuromuscular blocking drugs: a theoretical consideration on the underlying mechanisms

et al. 1995

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Nondepolarizing neuromuscular blocking drugs induce train-of-four (TOF) fade, i.e., the reduction of the fourth to the first twitch height in a train under TOF stimulation. It has been observed that the degree of TOF fade varies with the drug used and is inversely correlated with the potencies of the drug. In this study, the cause of difference of TOF fade was considered using a dynamic model. The model was based on the following assumptions: (1) Twitch response is evoked by the binding of acetylcholine (ACh) molecules to the postsynaptic nicotinic receptors in a neuromuscular junction, (2) time-dependent ACh mobilization in a motor nerve terminal results in less ACh output at the fourth stimulus in a train than at the first stimulus, (3) the drugs compete with ACh for the postsynaptic receptors and inhibit the receptor-binding of ACh, and (4) the drugs have various affinities for the receptors. This study suggested that the difference of affinities of the drugs for postsynaptic ACh receptors may cause the difference of TOF fade.

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Fading responses in the evoked EMG after rocuronium in cats

Shiraishi

Suzuki

et al. 1992

Can J Anaesth

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This study was performed to evaluate the inhibitory effect on motor nerve terminals by rocuronium using recovery curves of muscle compound action potentials (CAPs) and train-of-four ratios (TOFRs) in anaesthetized cats, and to compare the results with other relaxants reported previously. Recovery curves were derived from the amplitude of the CAP induced in the gastrocnemius muscle by the second of a paired stimulus (test response) to the sciatic nerve and compared with results evoked by the first component (conditioning response). The interval between the paired stimuli was increased stepwise from 7 to 1,000 msec, and the differences in amplitude of the test and conditioning responses were plotted on a graph by relating the changes in paired intervals. The recovery curve after rocuronium was less inhibited than after pancuronium, (100.4 +/- 5.9%, 82.3 +/- 6.7% and 68.5 +/- 6.7% at 60, 100 and 500 msec intervals, compared with 70.3 +/- 3.3%, 59.0 +/- 4.7% and 46.7 +/- 4.3% after pancuronium (P < 0.05). The recovery curves with d-tubocurarine were more depressed than with pancuronium; however, the RC with vecuronium was similar to that of rocuronium. The degree of fade in TOF by rocuronium was also less than those seen with d-tubocurarine and pancuronium. The results obtained suggest that rocuronium has less inhibitory effect on motor nerve terminals than do d-tubocurarine and pancuronium, and has a similar effect to that of vecuronium.

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Train–of–four fade during onset of neuromuscular block with nondepolarising neuromuscular blocking agents

Cited by 20 publications

References 13 publications

Neuromuscular blocking effects and train‐of‐four fade with cisatracurium: comparison with other nondepolarising relaxants

Neuromuscular blocking effects and train‐of‐four fade with cisatracurium: comparison with other nondepolarising relaxants

Difference of train-of-four fade induced by nondepolarizing neuromuscular blocking drugs: a theoretical consideration on the underlying mechanisms

Fading responses in the evoked EMG after rocuronium in cats

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