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BJA Advance Access published online on November 18, 2005
British Journal of Anaesthesia, doi:10.1093/bja/aei273
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2005. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org
Accepted October 13, 2005

Clinical Investigation

Normalization of acceleromyographic train-of-four ratio by baseline value for detecting residual neuromuscular block

T. Suzuki 1 *, N. Fukano 1, O. Kitajima 1, S. Saeki 1, and S. Ogawa 1

1 Department of Anesthesiology, Surugadai Nihon University Hospital, 1-8-13, Kanda-Surugadai, Chiyoda-Ku, Tokyo 101-8309, Japan

* To whom correspondence should be addressed.
T. Suzuki, E-mail: suzukit{at}cd5.so-net.ne.jp


  Abstract

Background. This study was designed to recognize the importance of normalizing postoperative acceleromyographic train-of-four (TOF) ratio by the baseline TOF value obtained before neuromuscular block for ensuring adequate recovery of neuromuscular function.

Methods. In 120 patients, TOF responses of the adductor pollicis to the ulnar nerve stimulation were monitored by acceleromyography (AMG) during anaesthesia using propofol, fentanyl and nitrous oxide. Control TOF stimuli were administered for 30 min. A TOF ratio measured at the end of control stimulation was regarded as a baseline value. Neuromuscular block was induced with vecuronium 0.1 mg kg-1 and was allowed to recover spontaneously. Duration to a TOF ratio of 0.9 as calculated by AMG (DUR-raw 0.9) was compared with that of 0.9 as corrected by the baseline TOF ratio (i.e. 0.9xbaseline TOF ratio; DUR-real 0.9).

Results. Baseline TOF ratios ranged from 0.95 to 1.47. The average TOF ratios observed every 5 min were constant throughout control stimulation from at time zero mean (SD) [range]; 1.11 (0.09) [0.94-1.42] to at 30 min 1.13 (0.11) [0.95-1.47]. The DUR-real 0.9 was 91.0 (18.0) [51.3-131.0] min and was significantly longer than the DUR-raw 0.9 (81.2 (16.3) [41.3-123.0] min).

Conclusions. Baseline TOF ratios measured by AMG are usually more than 1.0 and vary widely among patients. Therefore a TOF ratio of 0.9 displayed postoperatively on AMG does not always represent adequate recovery of neuromuscular function and should be normalized by baseline value to reliably detect residual paralysis.

Keywords: monitoring; acceleromyography; monitoring; neuromuscular function; train-of-four ratio; neuromuscular block; vecuronium.
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Normalization to detect Residual paralysis?
Thomas Fuchs-Buder
British Journal of Anaesthesia, 10 May 2006 [Full text]

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