Clinical evaluation of double‐burst stimulation Its relationship to train‐of‐four stimulation

Summary Double‐burst stimulation was compared with train‐of‐four stimulation in 23 adult patients receiving atracurium. Train‐of‐four was interrupted in 11 subjects every 2 minutes by one double‐burst stimulation, and re‐applied 6–30 seconds later; the height of the first double‐burst response, compared with its control, was depressed slightly more than T1. The relationship between double‐burst stimulation ratio and train‐of‐four ratio was indistinguishable from the line of identity. The train‐of‐four response, if repeated more than 12 seconds after double‐burst stimulation, was not depressed compared with pre double‐burst stimulation values. Fifteen anaesthetists were asked to detect fade manually in the second part of the study, while train‐of‐four was recorded on the opposite arm. One hundred and fourteen determinations were made in 12 patients. Fade was detected manually more often with double‐burst stimulation than with TOF.