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Anesth Analg 1986; 65:771-776
© 1986 International Anesthesia Research Society
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Electrical and Mechanical Train-of-Four Responses during Depolarizing and Nondepolarizing Neuromuscular Blockade

Stanley Weber, MD, and Stanley Muravchick, MD, PhD

Department of Anesthesiology and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, and the Department of Anesthesia, University of Pennsylvania, School of Medicine, Philadelphia, Pennsylvania.

Abstract

Simultaneous measurements of train-of-four (TOF) responses by integrated electromyography (IEMG) and twitch force were compared for atracurium, vecuronium, and succinylcholine in 30 subjects during nitrous oxide-fentanyl anesthesia. Determinations of TOF were made during neuromuscular blockade (NMB) onset and recovery. Scatter-grams and least squares regression lines were plotted, and z-tests for parallel slope and common intercept were used to compare lines. Data for atracurium and vecuronium were indistinguishable in all groups (z < 0.05), and therefore pooled to represent nondepolarizing blockade. During onset of nondepolarizing NMB, TOF showed a linear relationship indistinguishable from the line of identity (slope 0.93, intercept –0.06, z < 0.05). During recovery the intercept was unchanged (z > 0.05), but the slope was significantly changed, indicating mechanical TOF lags behind IEMG during recovery. This finding is important for interpretation of IEMG when used for clinical monitoring. Comparison of data for depolarizing NMB shows more complex relationships. Integrated electromyography is found to be convenient and reliable for monitoring nondepolarizing NMB.

Key Words: MEASUREMENT TECHNIQUES—electromyography • MONITORING—neuromuscular function • NEUROMUSCULAR RELAXANTS—atracurium, vecuronium, succinylcholine






Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 1986 by the International Anesthesia Research Society.