Method of intraoperative monitoring of neuromuscular function and residual blockade in the recovery room.

K. A. Jones, R. L. Lennon, Michael Hosking

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

We evaluated the method used intraoperatively to assess the degree of neuromuscular blockade prior to pharmacologic reversal to determine its role in preventing residual blockade in the postanesthesia care unit (PACU). We studied 38 patients who received a nondepolarizing muscle relaxant during general anesthesia for carotid endarterectomy or thoracotomy. The anesthesiologist assessed the degree of neuromuscular blockade intraoperatively prior to pharmacologic reversal either by the standard method of visually counting the number of evoked thumb twitches elicited by supramaximal train-of-four stimulation of the ulnar nerve (i.e., thumb train-of-four count), or by an alternative method such as 1) visually counting the number of evoked orbicularis oculi muscle twitches elicited by supramaximal train-of-four stimulation of the facial nerve, or 2) observing the patient for clinical evidence of partial recovery (e.g., swallowing or attempts to breathe). Residual blockade in the PACU was defined as 1) a train-of-four ratio less than 0.70 (measured by a mechanomyograph), or 2) the inability of the patient to perform clinical tests of neuromuscular function (e.g., a sustained head lift for 5 seconds) and evidence of neuromuscular weakness that was resolved following administration of edrophonium. Five of the 22 patients (23%) in whom one of the alternative methods was used had residual blockade in the PACU; none of the 16 patients with a thumb train-of-four count of 3 or 4 before pharmacologic reversal of NMB had residual blockade in the PACU (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Original languageEnglish (US)
Pages (from-to)23-26
Number of pages4
JournalMinnesota Medicine
Volume75
Issue number7
StatePublished - Jul 1 1992
Externally publishedYes

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Delayed Emergence from Anesthesia
Intraoperative Monitoring
Recovery Room
Thumb
Neuromuscular Blockade
Edrophonium
Muscles
Ulnar Nerve
Carotid Endarterectomy
Facial Nerve
Thoracotomy
Deglutition
General Anesthesia
Head

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Method of intraoperative monitoring of neuromuscular function and residual blockade in the recovery room. / Jones, K. A.; Lennon, R. L.; Hosking, Michael.

In: Minnesota Medicine, Vol. 75, No. 7, 01.07.1992, p. 23-26.

Research output: Contribution to journalArticle

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