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British Journal of Anaesthesia, 2000, Vol. 85, No. 6 856-860
© 2000 The Board of Management and Trustees of the British Journal of Anaesthesia

Simultaneous determination of neuromuscular block at the larynx, diaphragm, adductor pollicis, orbicularis oculi and corrugator supercilii muscles

T. M. Hemmerling, J. Schmidt, C. Hanusa, T. Wolf and H. Schmitt

Department of Anaesthesiology, University Erlangen-Nuremberg, Germany*Corresponding author: Centre Hospitalier de l’Université de Montréal, Hotel-Dieu, Départment de l’anesthésie, 3840 Rue Saint-Urbain, Montréal (Quebec) H2W 1T8, Canada

We simultaneously determined the neuromuscular blocking effect of mivacurium 0.2 mg kg–1 at five muscles in 20 women undergoing gynaecological surgery. Evoked electromyographic responses were obtained using surface electromyography (EMG) at the adducting laryngeal muscles, the diaphragm (lateral to vertebrae T12/L1 or L1/L2) and the adductor pollicis muscle and acceleromyographic (AMG) responses were measured at the orbicularis oculi and the corrugator supercilii muscle. Onset time and times for the first twitch response (T1/T0) to return to 25, 75 and 90% at the adducting laryngeal muscles and the diaphragm were significantly (P<0.005) shorter than at the adductor pollicis, the corrugator supercilii or the orbicularis oculi muscles (mean (SD) onset time: 89 (26) s and 78 (17) s to 202 (45) s, 152 (41) s, 194 (40) s; T1/T0=25%: 10.4 (1.5) and 11.4 (1.2) min versus 20.5 (3.9), 15.9 (3.3), 16.3 (3.7) min; T1/T0=90%: 15.5 (1.6) and 16.1 (1.6) min versus 27.4 (4.6), 21.5 (3.8), 23.3 (5.1) min). Onset and clinical duration of neuromuscular block at the larynx and the diaphragm after mivacurium 0.2 mg kg–1 are shorter than in the peripheral muscles. Monitoring of neuromuscular block in the diaphragm was successfully used in all patients.

Br J Anaesth 2000; 85: 856–60


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