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Anesth Analg 2005;100:1348-1351
© 2005 International Anesthesia Research Society
doi: 10.1213/01.ANE.0000148693.12874.22

ANESTHETIC PHARMACOLOGY

The Quantitative Distinction Between Train-of-Four "Counts of 2" and Posttetanic "Counts of 2" Evidenced by a Stable Paralysis/Stable Infusion Rate Method in Anesthetized Patients Receiving Mivacurium

A. A. d’Hollander, MD, PhD, A. V. Pytel, MD, B. M. Merzouga, MD, and C.-E. Klopfenstein, MD

Service d’ Anesthésiologie, Hôpital Universitaire de Genève, Genève, Switzerland

Address correspondence to A. A. d’Hollander, Service d’ Anesthésiologie, Hôpital Universitaire de Genève, 24 Rue Micheli-du-Crest, 1211 Genève, Suisse. Address e-mail to dhollanderalain{at}yahoo.fr.

In this study we quantitatively evaluated, by a stable paralysis/stable infusion rate method, the difference between two standardized paralysis levels—train-of-four (TOF) count of 2 responses and posttetanic count (PTC) of 2. Ten ASA physical status I–II consenting adult patients scheduled for elective surgery were anesthetized (sufentanil/propofol), tracheally intubated, mechanically normoventilated with a fixed O2/air mixture, and normothermic; oropharynx and thenar temperatures were maintained above 36° and 32.5°C, respectively. After partial recovery from 200 µg/kg mivacurium (MIV), stable tactile TOF and PTC counts of 2 paralysis levels were induced on the adductor pollicis muscle by manual adjustments of an infusion pump containing MIV. The paralysis levels and the infusion rates were considered as stable once they remained constant at 4 consecutive time points separated by 5 min each. Infusion rates observed were: TOF count 2–6 (2–11) and PTC 2–17 (3–18) µg · kg–1 · min–1 (P < 0.001; Wilcoxon’s paired comparison test). Under the present conditions, obtaining and maintaining a PTC of 2 requires MIV infusion rates far in excess of the "standard" recommendations mentioned in the literature for MIV infusion management.






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 © 2005 by the International Anesthesia Research Society.