Abstract
The relationship between post-tetanic twitch (PTT) and train-of-four (TOF) responses after intravenous administration ofvecuronium were studied using EMG in 20 patients under nitrous oxide and enflurane anesthesia. After the initial dose (0.2 mg·kg−l) of vecuronium, the detectable first twitch of PTT (PTT1) always preceded that of TOF (TOF1) with the mean time interval of 10.7±2.6 min. The post-tetanic count (PTC) which coincided with the first appearance of TOF1 was 9.4±2.6. After the appearance of TOF1, the magnitude of TOF1 was almost identical to that of PTC10 until full recovery from neuromuscular blockade was observed, whether the supplemental doses of vecuronium (0.03–0.04 mg·kg−l i.v.) were administered or not. The magnitude of TOF2 was slightly lower than that of PTC20. These results suggest that there is a close relationship between these two types of response, and by evaluating not only PTC but also the magnitude of each PTT, the recovery of TOF responses can be predicted and its extent be estimated fairly accurately.
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References
Viby-Mogensen J, Howardy-Hansen P, Chraemmer-Jørgensen B, et al: Posttetanic count (PTC): A new method of evaluating an intense nondepolarizing neuromuscular blockade. Anesthesiology 55:458–461, 1981
Fernando PUE, Viby-Mogensen J, Bonsu AK, et al: Relationship between posttetanic count and response to carinal stimulation during vecuronium-induced neuromuscular blockade. Acta Anaesth Scand 31:593–596, 1987
Bonsu AK, Viby-Mogensen J, Fernando PU, et al: Relationship of post-tetanic count and train-of-four response during intense neuromuscular blockade caused by atracurium. Br J Anaesth 59:1089–1092, 1987
Ridley SA, Hatch DJ: Post-tetanic count and profound neuromuscular blockade with atracurium infusion in paediatric patients. Br J Anaesth 60:31–35, 1988
Ridley SA, Braude N: Post-tetanic count and intense neuromuscular blockade with vecuronium in children. Br J Anaesth 61:551–556, 1988
Gwinnutt CL, Meakin G: Use of the posttetanic count to monitor recovery from intense neuromuscular blockade in children. Br J Anaesth 61:547–550, 1988
Ali HH, Utting JE, Gray C: Stimulus frequency in the determination of neuromuscular block in humans. Br J Anaesth 42:967–977, 1970
Rupp SM, Miller RD, Gencarelli PJ: Vecuronium-induced neuromuscular blockade during enflurane, isoflurane, and halothane anesthesia in humans. Anesthesiology 60:102–105, 1984
Williams NE, Webb SN, Calvey TN: Differential effects of myoneural blocking drugs on neuromuscular transmission. Br J Anaesth 52:1111–1115, 1980
Baker T, Aguero A, Stance A: Prejunctional effects of vecuronium in the cat. Anesthesiology 65:480–484, 1986
Bowman WC: Prejunctional and postjunctional cholinoceptors at the neuromuscular junction. Anesth Analg 59:935–943, 1980
Waud BE: Decrease in dose requirement of d-tubocurarine by volatile anesthetics. Anesthesiology 51:298–302, 1979
Feldman SA, Tyrell MF: A new theory of the termination of action of the muscle relaxants. Proc R Soc Med 63:692–695, 1970
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Toyooka, H., Noguchi, Y., Ebata, T. et al. A close relationship between post-tetanic twitch and train-of-four responses during neuromuscular blockade by vecuronium. J Anesth 5, 146–152 (1991). https://doi.org/10.1007/s0054010050146
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DOI: https://doi.org/10.1007/s0054010050146