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Retracted: Evaluation of residual neuromuscular blockade using modified double burst stimulation
Author(s) -
SAITOH Y.,
NAKAZAWA K.,
MAKITA K.,
TANAKA H.,
TOYOOKA H.
Publication year - 1997
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/j.1399-6576.1997.tb04776.x
Subject(s) - neuromuscular blockade , neuromuscular monitoring , medicine , blockade , isoflurane , anesthesia , neuromuscular transmission , forearm , stimulation , surgery , receptor
Background: To assess the degree of residual neuromuscular blockade, double burst stimulation (DBS) is commonly applied in the clinical setting. However, fades in response to DBS 3,3 can rarely be identified manually when train‐of‐four (TOF) ratios are ≧0.70, and, in contrast, fades in response to DBS 3,2 are felt manually in an undesirably high proportion of cases, even at TOF ratios greater than 0.7. We investigated whether a new monitoring method, modified DBS, would be useful to determine an adequate degree of recovery from neuromuscular blockade. For modified DBS, two burst stimuli were applied at an interval of 750 ms. The first stimulation in the modified DBS consisted of two stimuli of 0.3 ms duration at 50 Hz and the second of two stimuli of 0.2 ms duration at 50 Hz. Methods: Forty‐five adult patients undergoing elective nitrous oxide‐oxygen‐isoflurane anesthesia were randomly divided into one of three groups: DBS 3,3 group (n=15), DBS 3,2 group (n=15), or modified DBS group (n=15). During recovery from vecuroni‐um‐induced neuromuscular blockade, on both forearms, DBS 3, 3 , DBS 3, 2 , and modified DBS were delivered in the DBS 3, 3 group, DBS 3, 2 group, and modified DBS group, respectively. One hand and forearm (fixed arm) were immobilized to quantify the degree of neuromuscular blockade mechanically, and the contralateral arm (free arm) was unrestrained. An observer deter‐mined tactilely on the free arm the presence or absence of fade in response to the three DBS patterns. Results: Probabilities of detection of fade in response to the DBS 3, 3 were 67% (TOF ratio of 0.51–0.60), 40% (0.61–0.70), 19% (0.71–4).80), 5% (0.81–0.90), and 0% (0.91–1.00). Those to the DBS 3 , 2 were 95% (0.51–0.60), 93% (0.61–0.70), 83% (0.71–0.80), 65% (0.81–0.90), and 38% (0.91–1.00). Those to modified DBS were 90% (0.51–0.60), 86% (0.61–0.70), 65% (0.71–0.80), 25% (0.81–0.90), and 3% (0.91–1.00). The modified DBS was more sensitive in diagnosing residual neuromuscular blockade than DBS 3, 3 at the TOF ratio of 0.51–0.90, but was less sensitive than DBS 3, 2 at the TOF ratio of 0.81–1.00 ( P < 0.05). Conclusion: Our results indicate that the modified DBS may be a useful stimulation pattern to diagnose the adequacy of recovery from neuromuscular blockade.