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Clinical Investigation:
G. Dhonneur, K. Kirov, C. Motamed, R. Amathieu, W. Kamoun, V. Slavov, and S-K. Ndoko
Post-tetanic count at adductor pollicis is a better indicator of early diaphragmatic recovery than train-of-four count at corrugator supercilii
Br. J. Anaesth. 2007; 0: aem124v1-4 [Abstract] [Full text] [PDF]
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[Read E-letter] Comment on “Post-tetanic count at adductor pollicis is a better indicator of early diaphragmatic rec
Adriano Hobaika, Émerson Rezende   (10 September 2007)

Comment on “Post-tetanic count at adductor pollicis is a better indicator of early diaphragmatic rec 10 September 2007
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Adriano Hobaika,
Staff Anaesthetist
Hospital SOCOR,
Émerson Rezende

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Re: Comment on “Post-tetanic count at adductor pollicis is a better indicator of early diaphragmatic rec

We read with interest the work of Dhonneur et al 1. Monitoring of diaphragmatic neuromuscular blockade is very important to prevent cough or movements that could compromise delicate surgeries but currently there is no simple method 2. In searching for a reliable clinical method, the authors found that post tetanic count (PTC) applied on the adutor pollicis (AP) detects diaphragmatic neuromuscular recovery earlier than train of four (TOF) applied on the corrugator supercilii (CS). However, PTC is able to monitor deeper levels of muscular relaxation than TOF and PTC also predicts the return of TOF’s first answer 3. In addition, neuromuscular recovery of CS reflects better the blockade recovery of resistant muscles 4 and TOF CS monitoring is superior to quantify the degree of abdominal muscle recovery 5. Therefore, it is possible that PTC monitoring on CS may be the earliest method to detect diaphragmatic neuromuscular recovery.

References

1. Dhonneur G, Kirov K, Motamed C, et al. Post-tetanic count at adductor pollicis is a better indicator of early diaphragmatic recovery than train-of-four count at corrugator supercilii. Br J Anaesth 2007; 99:376-9. 2. Hemmerling TM, Le N. Brief review: Neuromuscular monitoring: an update for the clinician. Can J Anaesth 2007; 54:58-72. 3. Hemmerling TM, Donati F. Neuromuscular blockade at the larynx, the diaphragm and the corrugator supercilii muscle: a review. Can J Anesth 2003; 50:779–94. 4. Plaud B, Debaene B, Donati F. The corrugator super¬cilii, not the orbicularis oculi, reflects rocuronium neu¬romuscular blockade at the laryngeal adductor muscles. Anesthesiology 2001; 95: 96–101. 5. Kirov K, Motamed C, Ndoko SK, Dhonneur G. TOF count at corrugator supercilii reflects abdominal muscles relaxation better than at adductor pollicis. Br J Anaesth 2007; 98:611-4.

Conflict of Interest:

None declared