Tactile fade detection with hand or wrist stimulation using train-of-four, double-burst stimulation, 50-hertz tetanus, 100-hertz tetanus, and acceleromyography

Anesthesia and Analgesia
Florent CapronFrançois Donati

Abstract

Residual neuromuscular blockade can be evaluated using acceleromyography, tactile assessment of train-of-four (TOF), double-burst stimulation (DBS), 50-Hz tetanus, or 100-Hz tetanus. Nerve stimulation can be at the hand or the wrist. We compared all these tests at both sites of stimulation. Rocuronium was given to 32 patients under sevoflurane anesthesia. The mechanomyographic adductor pollicis TOF ratio was measured at one extremity. In the other, stimulation was at the hand or the wrist, by random allocation, and the acceleromyographic TOF ratio was measured. During recovery, a blinded observer estimated tactile fade. The TOF fade became undetectable when mechanomyographic TOF ratio was (mean +/- sd) 0.31 +/- 0.15. For DBS, this threshold was 0.76 +/- 0.11. For 50-Hz tetanus, it was 0.31 +/- 0.15. For 100-Hz tetanus, it was 0.88 +/- 0.18, with a range of 0.14-1.00. These tactile responses were the same for hand and wrist stimulation. When acceleromyographic TOF ratio reached 1.0, the mechanomyographic TOF ratio was 0.89 +/- 0.06. With stimulation in the hand, acceleromyographic TOF ratio >1.0 was less frequent than at the wrist. To exclude residual paralysis, TOF, DBS, and 50-Hz tetanus are inadequate, 100-Hz tetanus is unrel...Continue Reading

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Citations

Apr 30, 2013·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·François Donati
Dec 23, 2014·Current Anesthesiology Reports·Hassan FarhanMatthias Eikermann
Oct 22, 2011·Annales Françaises D'anesthèsie Et De Rèanimation·F Donati
Oct 27, 2009·Annales Françaises D'anesthèsie Et De Rèanimation·A-A d'Hollander, J-L Bourgain
Feb 19, 2009·Anaesthesia·C ClaudiusJ Viby-Mogensen
Feb 19, 2009·Anaesthesia·J E Caldwell, R D Miller
Feb 19, 2009·Anaesthesia·A F Kopman, M Eikermann
Nov 19, 2011·Acta Anaesthesiologica Scandinavica·H MirzakhaniA Nozari
Feb 4, 2011·Acta Anaesthesiologica Scandinavica·J-U SchreiberT Fuchs-Buder
Aug 1, 2015·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·Sanjay M BhanankerStephan R Thilen
Apr 22, 2016·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·Robert J Hudson
Aug 11, 2017·Anesthesia and Analgesia·Glenn S Murphy
May 24, 2008·Anesthesiology·Casper Claudius, Jørgen Viby-Mogensen
Sep 16, 2009·Current Opinion in Anaesthesiology·Paul H AlfilleMatthias Eikermann
Mar 18, 2010·Anesthesiology·Benoît PlaudJean Marty
Nov 8, 2016·Anesthesiology·Sorin J Brull, Aaron F Kopman
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Jan 12, 2020·Anaesthesia Critical Care & Pain Medicine·Benoît PlaudBertrand Debaene
Dec 11, 2021·Seminars in Cardiothoracic and Vascular Anesthesia·Melissa L McKittrick, Frederick W Lombard

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