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British Journal of Anaesthesia, 2001, Vol. 87, No. 4 625-627
© 2001 The Board of Management and Trustees of the British Journal of Anaesthesia

Short Communications

Neuromuscular monitoring in intensive care patients: milliamperage requirements for supramaximal stimulation{dagger}

N. J. N. Harper, R. Greer and D. Conway

Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK*Corresponding author

{dagger} This work was presented in part at the Anaesthetic Research Society meeting in November 2000 at the Hammersmith Hospital, London.

We investigated the effects of peripheral oedema on the supramaximal current required for neuromuscular monitoring of critically ill patients. We studied 32 sedated patients who had not needed a neuromuscular blocking drug. The presence of oedema over the volar aspect of both wrists was assessed by a blinded observer and graded (grade 0, no oedema; grade 1, mild oedema; grade 2, gross oedema). The supramaximal current was derived by applying an incrementally increasing current over the ulnar nerve and measuring the amplitude of the electromyographic (EMG) response of the first dorsal interosseous muscle. The supramaximal current was that current above which there was no significant increase in EMG amplitude. It was 40 mA in the absence of oedema. This current was significantly increased in the presence of grade 1 oedema (60 mA, Mann–Whitney test, P<0.01) and grade 2 oedema (82.5 mA, Mann–Whitney test, P<0.01). In the presence of oedema, the required supramaximal current decreased significantly after the application of pressure over the stimulating electrodes (Wilcoxon signed rank test, P<0.05). Supramaximal current in critically ill patients is increased in the presence of peripheral oedema. We recommend that nerve stimulators used for neuromuscular monitoring in the ICU are capable of delivering a stimulus current of at least 100 mA.

Br J Anaesth 2001; 87: 625–7


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