Effect of partial neuromuscular blockade on intraoperative electromyography in patients undergoing resection of acoustic neuromas

R. L. Lennon, M. P. Hosking, J. R. Daube, J. O. Welna

Research output: Contribution to journalArticle

36 Citations (Scopus)

Abstract

Intraoperative electromyographic monitoring of the facial nerve during acoustic neuroma excision provides early detection of nerve injury and improved outcome. To determine whether a useful level of peripheral neuromuscular blockade could be achieved without compromise of facial electromyographic monitoring, we studied 10 patients undergoing resection of acoustic neuroma. Facial nerve monitoring was accomplished by placement of wire electrodes in the orbicularis oris, orbicularis occuli, and mentalis muscles. Peripheral neuromuscular blockade was assessed by recording unprocessed hypothenar compound muscle action potentials (CMAPs). After induction of anesthesia, an infusion of atracurium (1.0 μg · kg-1 · min-1) accompanied by a bolus dose of 50 μg/kg was admmistered. The infusion was then increased in increments of 0.5 μg · kg-1 · min-1 until a 50% reduction in hypothenar single-twitch CMAP was obtained. Facial nerve function was continuously monitored by comparison of facial CMAPs produced by stimulation of the nerve proximal and distal to the tumor bed. The mean (±SD) infusion rate of atracurium was 2.55 ± 0.75 μg · kg-1 · min-1. Decrements in facial nerve CMAPs were detected in 6 of 10 patients, and all demonstrated moderate to severe facial nerve dysfunction. In no patient was an unexpected deficit present postoperatively. Moderate degrees of peripheral neuromuscular blockade can be achieved without compromising facial nerve electromyographic monitoring.

Original languageEnglish (US)
Pages (from-to)729-733
Number of pages5
JournalAnesthesia and analgesia
Volume75
Issue number5
StatePublished - Jan 1 1992

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Neuromuscular Blockade
Acoustic Neuroma
Facial Nerve
Electromyography
Action Potentials
Atracurium
Muscles
Facial Muscles
Intraoperative Monitoring
Electrodes
Anesthesia
Wounds and Injuries
Neoplasms

All Science Journal Classification (ASJC) codes

  • Anesthesiology and Pain Medicine

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Effect of partial neuromuscular blockade on intraoperative electromyography in patients undergoing resection of acoustic neuromas. / Lennon, R. L.; Hosking, M. P.; Daube, J. R.; Welna, J. O.

In: Anesthesia and analgesia, Vol. 75, No. 5, 01.01.1992, p. 729-733.

Research output: Contribution to journalArticle

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