THE NEUROMUSCULAR BLOCKADE ONSET AND THE INTUBATING CONDITIONS DURING PANCURONIUM INTRUCTION
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Keywords
Neuromuscular blockade, intubating conditions, orbicularis oculi, adductor pollicis, pancuronium
Abstract
The purpose of the study was to compare the occurrence of neuromuscular blockade (NMB) and intubating conditions in two muscle groups orbicularis oculi (OO) and adductor pollicis (AP) in patients who were given pancuronium. Eighty adult patients, aged 15-50 years who were ASA grade I or II and underwent elective surgeries were enrolled. A train-of-four (TOF) stimulation of OO and AP muscles was visually used to determine the time of onset of NMB. The findings demonstrated that NMB monitored at OO gave satisfactory intubating conditions 64 +/- 11.51 seconds before those monitored by AP. Conditions at intubation were equally good in both the groups with Group II (AP) showing a little better result. The time to NMB development at OO was much quicker than at AP with a mean difference of 62.20 12.76 seconds (p < 0.001) in both groups. The more rapid onset at OO may be explained by the fact that it has a greater perfusion and is closer to the central circulation than the more peripheral AP muscle. The conclusion of the work is that observation of the development of NMB at the OO muscle can provide a more predictable and earlier sign of the intubating conditions.
References
2. Donati F, Meistelman C, Plaud B. Vecuronium neuromuscular blockade at the diaphragm, the orbicularis oculi and adductor pollicis muscles. Anesthesiology 1990; 73: 870.
3. Ungureanu D, Meistelman C, Frossard J et al. The orbicularis oculi and the adductor pollicis muscles as monitors of atracurium block of laryngeal muscles. AnesthAnalg 1993; 77: 775.
4. Krieg N, Mazur L, Booji L.H.D.J. et al. Intubating conditions and reversibility of a new non-depolarizing neuromuscular blocking agent. Org NC 45. ActaAnesthesiolScand 1980; 24: 423-25.
5. Debaene B, Beaussier M, Meistelman C, Donati F, Lienhart A. Monitoring the onset of neuromuscular block at the orbicularis oculi can predict good intubating conditions during atracurium induced neuromuscular block. AnesthAnalg 1995; 80: 360-63.
6. Plaud B, Laffon M, Ecoffey C, Meistelman C. Monitoring orbicularis oculi predicts good intubating conditions after vecuronium in children. Can J Anesth 1997; 44: 712-16.
7. Donati F. Pharmacokinetic and pharmacodynamic factors in clinical use of muscle relaxants. Seminars in Anaesthesia. 1994; 13: 310-20.
8. Day NS, Blake CJ, Standaert FG, Dretchen KL. Characterization of the train–of–four responses in fast andslow muscle : effect of d-tubocurarine, pancuronium and vecuronium. Anesthesiology 1983; 58: 414-17.
9. Hemmerling TM, Schimidt J, Hanusa C, Wolf T, Schmidt H. : Simultaneous determination of neuromuscular block at the larynx, adductor pollicis, orbicularis oculi and corrugator supercilii muscles. Br J Anaesth 2000; 85: 856-60.
10. Smith CE, Donati F, Bevan DR. Different effects of pancuronium on masseter and adductor pollicis muscles in humans. Anesthesiology 1989; 71: 57-61.
11. Lecorre F, Plaud B, Benhamou E, Debaene B. Visual estimation of onset time at the orbicularis oculi after five muscle relaxants; application to clinical monitoring of tracheal intubation. Anesth 1999; 89: 1305-10.
12. O’Hara DA, Fragen RJ, Shanks CA. Comparison of visual and measured train–of–four after vecuronium inducedneuromuscular blockade using two anaesthetic techniques. Br J Anaesth 1986; 58: 1300-02.
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Dr N.S. Lakshmi Pallavi
Assisstant Professor, Department of Pathology, Arunai Medical College and Hospital, Velu Nagar, Mathur, Tiruvannamalai
Venkata Radhakrishna Varadapureddi
Associate Professor, Melmaru, vathurAdhiparasakthi Institute of Medical Sciences and Research, Melmaruvathur, Chengalpattu District, Tamilnadu, India 603319.