Visual Evaluation of Residual Curarization in Anesthetized Patients Using One Hundred-Hertz, Five-Second Tetanic Stimulation at the Adductor Pollicis Muscle

Baurain, Michel; Hennart, Daniele A.; Godschalx, Alexandre; Huybrechts, Isabelle; Nasrallah, Georges; D’Hollander, Alain; Cantraine, Francis

doi:10.1097/00000539-199807000-00038

Cited by 19 publications

(6 citation statements)

References 18 publications

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“…An important question regarding any in vitro study such as the present one, is whether the findings can be extrapolated to the in vivo situation and ideally to the clinical set-ting. In this regard, the effective plasma concentrations attained by atracurium in patients, calculated from its usual range of doses (0.3 to 0.6 mg/kg, Payne & Hughes 1981;Baurain et al 1998), volume of distribution (0.16 l/kg, Ward et al 1983) and molecular weight (1243.4, Stenlake et al 1983) is in the range of 1.5 to 3.0 mM. This overlaps the range of concentrations used in our experimental conditions in vitro.…”

Section: Discussionsupporting

confidence: 67%

“…This overlaps the range of concentrations used in our experimental conditions in vitro. So, it is fair to suppose that the mechanisms we disclosed for atracurium in vitro in the present work are also operative in vivo in the clinical setting, where atracurium is known to induce fade of the tetanic contraction (Payne & Hughes 1981;Baurain et al 1998) with similar characteristics to the fade observed in vitro in the present work.…”

Section: Discussionsupporting

confidence: 65%

“…However, we still lack knowledge regarding some of its cellular mechanisms and it is important to know more of a compound used so frequently in anaesthesiology. For example, similar to other clinically used blockers, atracurium induces fade of the tetanic contraction, both in vivo, in humans (Payne & Hughes 1981;Baurain et al 1998) and in vitro, in experimental animals (Gibb & Marshall 1986;Wali et al 1987Wali et al & 1989. However, the cellular mechanisms underlying this tetanic fade have never been systematically studied with intracellular microelectrode techniques.…”

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confidence: 99%

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Cellular Mechanisms of Atracurium‐Induced Tetanic Fade in the Isolated Rat Muscle

Nascimento

Serra

Oliveira

2004

Basic Clin Pharma Tox

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Although atracurium is a widely used neuromuscular blocker, we still lack knowledge regarding some of its cellular mechanisms of action. Thus, similar to other clinically used blockers atracurium induces, both in vivo and in vitro, fade of the tetanic contraction. However, the cellular mechanisms underlying this tetanic fade have never been systematically studied. In the present work these mechanisms were investigated in vitro. A sciatic nerve extensor digitorum longus muscle preparation of the rat was used. A combination of myographical and electrophysiological techniques was employed. Indirect twitches were evoked at 0.1 Hz and tetanic contractions at 50 Hz. Trains of end-plate potentials were evoked at a frequency of 50 Hz. The electrophysiological variables used in the analysis of the trains of end-plate potentials were: peak amplitude of the first end-plate potential in the train, peak amplitude of plateau end-plate potentials in the train, tetanic run-down of the end-plate potentials' train, quantal content of first and plateau end-plate potentials in the train, quantal size. In the myographical study atracurium, at a concentration of 2.4 mM, induced a complete fade of the tetanic contraction while only slightly affected the twitch. In the electrophysiological study atracurium, at the same 2.4 mM concentration, significantly decreased the amplitude of both first end-plate potentials in the train (control: 14.4 mV; atracurium: 3.2 mV) and plateau end-plate potentials (control: 10.8 mV; atracurium: 2.4 mV) and reinforced the tetanic run-down of the train of end-plate potentials, evaluated as the percent loss in amplitude of plateau end-plate potentials compared to first end-plate potentials in the trains (control: 25.2%; atracurium: 33.2%). Atracurium also significantly decreased the quantal content of first end-plate potentials in the train (control: 231; atracurium: 68), the quantal content of plateau end-plate potentials (control: 159; atracurium: 42) and the quantal size (control: 0.119 mV; atracurium: 0.075 mV). In relative terms the decrease in quantal content was about twice as large as the decrease in quantal size. This indicates that the fade of the tetanic contraction induced by atracurium (2.4 mM) is due to both pre-and postsynaptic blocking effects, the presynaptic one being stronger.

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Section: Discussionsupporting

confidence: 67%

Section: Discussionsupporting

confidence: 65%

mentioning

confidence: 99%

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Cellular Mechanisms of Atracurium‐Induced Tetanic Fade in the Isolated Rat Muscle

Nascimento

Serra

Oliveira

2004

Basic Clin Pharma Tox

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“…Baurain et al. [12] found a visual absence of fading after a 100 Hz, 5 s tetanic stimulation to be comparable to a TOF ratio of 0.85. However, recent studies of this topic have shown that the sensitivity of using a tetanic stimulation in detecting residual curarisation is about 70% but with a low specifity of only 50% [11].…”

Section: Basic Considerationsmentioning

confidence: 99%

Monitoring neuromuscular block: an update

2009

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SummaryThe first part of this article presents an update of the basic considerations of neuromuscular monitoring. It emphasises the need to assure supramaximal stimulation, to place the stimulating electrodes correctly and to use appropriate sites for nerve stimulation as well as appropriate stimulation patterns. The second part focuses on current developments and ongoing discussion. The authors describe the performance of acceleromyography and the need for initial calibration when using these quantitative devices.

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“…Relying on tactile or visual evaluation of fade after a 50 Hz or 100 Hz tetanic stimulation is also unreliable [88–90]. Feeling or observing fade in response to 100 Hz tetanic stimulation probably has the highest sensitivity in diagnosing PORC [90, 91]. However, some patients show fade even without exposure to a NMBA.…”

Section: Postoperative Residual Curarisationmentioning

confidence: 99%

The undesirable effects of neuromuscular blocking drugs

Claudius¹,

Garvey

Viby‐Mogensen

2009

Anaesthesia

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SummaryNeuromuscular blocking drugs are designed to bind to the nicotinic receptor at the neuromuscular junction. However, they also interact with other acetylcholine receptors in the body. Binding to these receptors causes adverse effects that vary with the specificity for the cholinergic receptor in question. Moreover, all neuromuscular blocking drugs may cause hypersensitivity reactions. Often the symptoms are mild and self-limiting but massive histamine release can cause systematic reactions with circulatory and respiratory symptoms and signs. At the end of anaesthesia, no residual effect of a neuromuscular blocking drug should be present. However, the huge variability in response to neuromuscular blocking drugs makes it impossible to predict which patient will suffer postoperative residual curarization. This article discusses the undesirable effects of the currently available neuromuscular blocking drugs including the definitions, diagnosis and causes of hypersensitivity reactions and postoperative residual curarisation.

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Visual Evaluation of Residual Curarization in Anesthetized Patients Using One Hundred-Hertz, Five-Second Tetanic Stimulation at the Adductor Pollicis Muscle

Cited by 19 publications

References 18 publications

Cellular Mechanisms of Atracurium‐Induced Tetanic Fade in the Isolated Rat Muscle

Cellular Mechanisms of Atracurium‐Induced Tetanic Fade in the Isolated Rat Muscle

Monitoring neuromuscular block: an update

The undesirable effects of neuromuscular blocking drugs

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