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British Journal of Anaesthesia, 2003, Vol. 90, No. 4 480-486
© 2003 The Board of Management and Trustees of the British Journal of Anaesthesia

Clinical Investigations

Monitoring of neuromuscular block after administration of vecuronium in patients with diabetes mellitus

Y. Saitoh1, K. Kaneda2, H. Hattori1, H. Nakajima1 and M. Murakawa1

1 Department of Anesthesiology, Fukushima Medical University School of Medicine, Hikarigaoka 1, Fukushima-City, Fukushima 960-1295, Japan. 2 Department of Anesthesiology, Toride Kyodo General Hospital, Ibaraki, Japan

Corresponding author. E-mail: ys@m6.people.or.jp

Background. We studied the supramaximal current for ulnar nerve stimulation during electromyographic monitoring of onset and recovery of neuromuscular block using a neuromuscular transmission module (M-NMT Module, Datex-Ohmeda) in patients with Type 2 diabetes undergoing anaesthesia with nitrous oxide, oxygen, isoflurane and fentanyl.

Methods. Thirty-six diabetic patients were randomly assigned to a post-tetanic count (PTC) group (n=17) or train-of-four (TOF) group (n=19). In addition, 30 non-diabetic patients were divided into control PTC (n=15) and TOF groups (n=15).

Results. In the diabetic patients (diabetes PTC and diabetes TOF groups), the mean supramaximal stimulating current was significantly higher than in the non-diabetic patients (control PTC and TOF groups) (50.5 (SD 14.1) vs 33.4 (6.1) mA, P<0.01). Onset of neuromuscular block (time to disappearance of T1) after vecuronium 0.1 mg kg–1 in the diabetic patients did not differ significantly from that in the non-diabetic patients (276 (77) vs 244 (44) s, P=0.055). Time to return of PTC1 did not differ significantly between the diabetes and control PTC groups (21.0 (12.1) vs 15.7 (5.0) min, P=0.126). Times to return of T1 and T4 in the diabetes TOF group were significantly longer than in the control TOF group (T1: 37.5 (15.2) vs 25.7 (7.6) min, P=0.01; T4: 61.4 (23.7) vs 43.5 (11.4) min, P=0.01). During recovery, PTC and T4/T1 in the diabetes PTC and TOF groups were similar to those in the control PTC and TOF groups, respectively. T1/T0 in the diabetes TOF group was significantly less than in the control TOF group, 80–120 min after vecuronium (P<0.05).

Conclusions. In diabetic patients, supramaximal current is higher than in non-diabetic patients. After vecuronium, onset of neuromuscular block and recovery of PTC or T4/T1 are not altered, but time to return of T1 or T4, and recovery of T1/T0 are delayed in diabetic patients.

Br J Anaesth 2003; 90: 480–6


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T. M. Hemmerling, G. Michaud, S. Deschamps, G. Trager, and Y. Saitoh
Monitoring neuromuscular blockade in diabetic patients using electromyography: an opportunity missed
Br. J. Anaesth., October 1, 2003; 91(4): 608 - 609.
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