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TOF Ratio (tof + ratio)
Selected AbstractsKnowledge of residual curarization: an Italian surveyACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 3 2010P. DI MARCO Background: The use of neuromuscular blocking agents (NMBAs) is widespread in anesthetic practice; little is known about the current use of these drugs in Italy. This survey was conducted to obtain information about the most commonly used clinical tests and the train-of-four (TOF) ratios that are considered as being reliable for assessing recovery from neuromuscular blockade at the end of anesthesia and the estimated occurrence rates of post-operative paralysis in Italian hospitals. Methods: The questionnaire was given to Italian anesthesiologists attending the 62nd National Congress of the Italian Society of Anesthesia, Analgesia and Intensive Therapy. Collected data were stratified by age and the total number of surgical procedures performed in the hospitals concerned. Results: Seven hundred and fifty-four correctly compiled questionnaires were collected (response rate 88.7%). Seventy three percent of the respondents only used clinical tests for monitoring the level of neuromuscular blockade. The main clinical tests cited for the evaluation of residual paralysis were keeping the head lifted up for 5 s, protruding the tongue and opening the eyes. TOF was used by 35% of the respondents on a routine basis. Only 24% of the interviewed anesthesiologists reported that before extubation, a TOF ratio of at least 0.9 should be reached. Conclusions: Most Italian anesthetists assess the recovery from neuromuscular blockade only by clinical signs. There is poor awareness about the inability of such techniques to indicate even a significant amount of residual neuromuscular block. A more extensive use of quantitative instrumental monitoring is required for the more rational use of NMBAs. [source] Infusion requirements and reversibility of rocuronium at the corrugator supercilii and adductor pollicis musclesACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 10 2009T. SUZUKI Background: The aim of this study is to compare the infusion rates required to maintain a constant neuromuscular block and the reversibility of rocuronium at the corrugator supercilii muscle (CSM) and the adductor pollicis muscle (APM). Methods: We randomly allocated 30 female patients into two groups of 15 patients each to monitor neuromuscular block at either the CSM or the APM. After induction of anaesthesia and laryngeal mask insertion, contraction of the CSM to the facial nerve stimulation or that of the APM to the ulnar nerve stimulation was quantified using an acceleromyograph during 1.0,1.5% end-tidal sevoflurane anaesthesia. All the patients received a bolus of 1 mg/kg rocuronium. When the first twitch (T1) of train-of-four (TOF) recovered to 10% of the control, rocuronium infusion was commenced and maintained at T1 of 10% of the control at the CSM or APM for 120 min. Immediately after rocuronium infusion was discontinued, the time required for 0.04 mg/kg neostigmine-facilitated recovery to a TOF ratio of 0.9 was recorded. Results: Rocuronium infusion dose after a lapse of 120 min was significantly larger in the CSM than in the APM [7.1 (2.3) vs. 4.7 (2.6) ,g/kg/min; P=0.001]. The time for facilitated recovery was shorter in the CSM than in the APM [11.4 (3.8) vs. 16.2 (6.0) min; P=0.016]. Conclusion: A larger rocuronium infusion dose was required to maintain a constant neuromuscular block at the CSM. Neostigmine-mediated reversal was faster at the CSM. [source] Attenuation of a rocuronium-induced neuromuscular block in patients receiving prednisoloneACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 4 2009S. SOLTÉSZ Background: This study tested the influence of continuous medication (more than 4 weeks) with prednisolone on a rocuronium-induced neuromuscular block. Methods: The time course of a rocuronium-induced neuromuscular blockade (0.3 mg/kg) was investigated in 40 patients with chronic inflammatory bowel disease undergoing elective abdominal surgery. The primary end point was the time from the start of injection of rocuronium until recovery of the TOF ratio to 0.9. Twenty patients received continuous medication with prednisolone (group A), and 20 were without glucocorticoid medication (group B). Additionally, another 20 patients without inflammatory bowel disease and without glucocorticoid medication served as control (group C). Results: The onset time was prolonged in group A [253 (51.2) s] compared with group B [187 (61.3) s]. Twitch height at the onset of the block was higher in group A [16.5 (0,61)%] than that in group B [5.0 (0,33)%]. The duration to 25% twitch height was shorter in group A [12.6 (0,20.7) min] compared with group B [16.7 (0,25.3) min] and group C [16.9 (0,29.3) min]. The recovery to a train-of-four ratio of 0.9 was reduced in group A [25.7 (23,34.3) min] compared with group B [34.7 (32.7,44.2) min] and group C [36.5 (31.7,42.3) min]. Conclusions: Prednisolone treatment in patients with inflammatory bowel disease is associated with a delayed onset and a shorter duration of action of rocuronium. The presence of an inflammatory bowel disease did not influence the neuromuscular block. [source] Reversal of rocuronium with edrophonium during propofol versus sevoflurane anesthesiaACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 2 2001T. J. Zhou Background: The use of volatile anesthetics for maintenance of anesthesia can enhance the action of non-depolarizing muscle relaxants and interfere with the reversal of neuromuscular blockade. In this study, we studied the antagonism of rocuronium with edrophonium-atropine during propofol- versus sevoflurane-based anesthesia. Methods: Following induction of anesthesia with propofol (2,2.5 mg kg,1, iv) and fentanyl (1,2 ,g kg,1 iv), rocuronium 0.6 mg kg,1 iv was administered to facilitate tracheal intubation. Patients were then randomized to receive either a propofol infusion (100 ,g kg,1 min,1) or sevoflurane (1.0%, end-tidal) in combination with nitrous oxide 66% for maintenance of anesthesia. Neuromuscular blockade was monitored using electromyography at the wrist, and reversed with edrophonium 1.0 mg kg,1 and atropine 0.015 mg kg,1 when the first twitch hight (T1) of the train-of-four (TOF) stimulation recovered to 25% of the baseline value. Anesthetic maintenance with propofol or sevoflurane was continued following reversal until a TOF ratio of 0.7 was attained. Results: The clinical duration of action (i.e., time to 25% T1 recovery) was similar during both propofol- (39.3±14.6 min) and sevoflurane-based (48.1±19.7 min) anesthesia. However, the reversal time from 25% T1 to TOF ratio of 0.7 was significantly longer with sevoflurane [Median 2.8 (range 0.5,18.8) min] compared with propofol [1.5 (0.75,3) min] (P<0.05). Conclusions: We conclude that the clinical duration of action after a single dose of rocuronium, 0.6 mg kg,1 iv, was similar during both propofol- and sevoflurane-based anesthesia. However, the reversal of rocuronium-induced residual blockade was slower and more variable in the presence of sevoflurane. [source] Reversal of rocuronium-induced neuromuscular blockade by pyridostigmine in patients with Duchenne muscular dystrophyPEDIATRIC ANESTHESIA, Issue 3 2008TINO MUENSTER MD Summary Background:, The aim of this study was to investigate the effect and safety of pyridostigmine for the reversal of a neuromuscular block (NMB) in patients with Duchenne muscular dystrophy (DMD). In patients with DMD recovery from a rocuronium-induced NMB is markedly delayed. Methods:, Fourteen DMD patients (aged between 11 and 19 years) scheduled for elective scoliosis repair were studied. Following tracheal intubation without muscle relaxant, all patients received a single dose of rocuronium 0.6 mg·kg,1. NMB was monitored by acceleromyography at the adductor pollicis muscle. When the first twitch height (T1) of the train-of-four (TOF) had recovered to 25% seven patients received either pyridostigmine 0.1 mg·kg,1 (the anticholinergic drug with a long duration of action) or saline in a blinded manner. The times to attain TOF ratio of 0.9 were recorded. For comparison the Mann,Whitney U -test was used. Results:, Recovery to TOF ratio of 0.9 was significantly (P < 0.05) accelerated by pyridostigmine [84 (median), 57,141(range)] compared with controls (148, 84,243 min). The recovery time (time between T1 of 25% and TOF of 90%) was also significantly (P < 0.01) shortened by pyridostigmine (15, 8,49 vs 76, 43,144 min, respectively). Time to recovery of T1 to 90% was not different between the groups (108, 63,134 vs 169. 61,208 min, respectively). Conclusions:, Pyridostigmine 0.1 mg·kg,1 effectively reversed a rocuronium-induced NMB in DMD patients. [source] | ||||||||||