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Anesth Analg 2006;102:1578-1584
© 2006 International Anesthesia Research Society
doi: 10.1213/01.ane.0000204288.24395.38

GENERAL ARTICLES

Tactile Fade Detection with Hand or Wrist Stimulation Using Train-of-Four, Double-Burst Stimulation, 50-Hertz Tetanus, 100-Hertz Tetanus, and Acceleromyography

Florent Capron, MD, Louis-Philippe Fortier, MSc, MD, FRCPC, Sébastien Racine, MSc, and François Donati, PhD, MD, FRCPC

Department of Anesthesiology, Hôpital Maisonneuve-Rosemont and Université de Montréal, Québec, Canada

Address correspondence and reprint requests to François Donati, PhD, MD, Department of Anesthesiology, Hôpital Maisonneuve-Rosemont, 5415, boul. l'Asssomption, Montréal, Québec, Canada H1T 2M4. Address e-mail to francois.donati{at}umontreal.ca.

Residual neuromuscular blockade can be evaluated using acceleromyography, tactile assessment of train-of-four (TOF), double-burst stimulation (DBS), 50-Hz tetanus, or 100-Hz tetanus. Nerve stimulation can be at the hand or the wrist. We compared all these tests at both sites of stimulation. Rocuronium was given to 32 patients under sevoflurane anesthesia. The mechanomyographic adductor pollicis TOF ratio was measured at one extremity. In the other, stimulation was at the hand or the wrist, by random allocation, and the acceleromyographic TOF ratio was measured. During recovery, a blinded observer estimated tactile fade. The TOF fade became undetectable when mechanomyographic TOF ratio was (mean ± sd) 0.31 ± 0.15. For DBS, this threshold was 0.76 ± 0.11. For 50-Hz tetanus, it was 0.31 ± 0.15. For 100-Hz tetanus, it was 0.88 ± 0.18, with a range of 0.14–1.00. These tactile responses were the same for hand and wrist stimulation. When acceleromyographic TOF ratio reached 1.0, the mechanomyographic TOF ratio was 0.89 ± 0.06. With stimulation in the hand, acceleromyographic TOF ratio >1.0 was less frequent than at the wrist. To exclude residual paralysis, TOF, DBS, and 50-Hz tetanus are inadequate, 100-Hz tetanus is unreliable, and acceleromyography performs best.




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Does Fade with 100-Hz Tetanic Stimulation Reliably Detect Residual Neuromuscular Blockade?
Anesth. Analg., January 1, 2007; 104(1): 215 - 215.
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Home page
 Anesth. Analg.Home page
F. Donati
Does Fade with 100-Hz Tetanic Stimulation Reliably Detect Residual Neuromuscular Blockade?
Anesth. Analg., January 1, 2007; 104(1): 215 - 216.
[Full Text] [PDF]


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 © 2006 by the International Anesthesia Research Society.