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ANESTHETIC PHARMACOLOGY

A Comparison Between Anterior and Posterior Monitoring of Neuromuscular Blockade at the Diaphragm: Both Sites Can Be Used Interchangeably

Thomas M. Hemmerling, MD DEAA^*, Joachim Schmidt, MD, Christian Schurr, Georg Breuer, MD, and Klaus E. Jacobi, MD

*Department of Anesthesiology, University of Montreal, Canada; and Department of Anesthesiology, University of Erlangen-Nuremberg, Erlangen, Germany

Address correspondence and reprint requests to T.M. Hemmerling, MD, DEAA, Department of Anesthesiology, University of Montreal, Hotel-Dieu, 3580 Rue Saint Urbain, Montreal (Quebec) H2W 1T8, Canada. Address e-mail to thomashemmerling{at}hotmail.com

We present a novel site of monitoring neuromuscular blockade of the diaphragm at the patient’s back. After the induction of anesthesia, 12 patients were orotracheally intubated. Two Ag/AgCl-electrodes were attached at the right seventh or eighth intercostal space between the midclavicular and anterior axillary line; two Ag/AgCl-electrodes were paravertebrally attached on the right side lateral to vertebrae T12-L1 or L1-2. Two Ag/AgCl-skin-electrodes were placed over the right thenar area for an electromyography recording of the adductor pollicis (AP) muscle, and two Ag/AgCl-skin-electrodes were used to stimulate the ulnar nerve. Onset and offset of neuromuscular blockade after rocuronium 0.6 mg/kg were determined, and significant differences between diaphragm and AP muscle and agreement between the two methods were determined. Mean maximum block was more than 96% at all sites. Lag time, onset 50, and onset time were not significantly different between the diaphragm and the AP. However, time to reach 25% of control twitch was significantly longer at the AP muscle than at the diaphragm (P < 0.001). The difference of the means and limits of agreement between the anterior and the posterior site of diaphragmatic monitoring were 0 ± 11 s, 3 ± 9 s, 0 ± 19 s, and -2% ± 5% for lag, onset 50, onset time, and peak effect, respectively, and -2 ± 2 min for the time to reach 25% of control twitch of neuromuscular blockade. We conclude that anterior and posterior diaphragmatic monitoring can be used interchangeably to determine neuromuscular blockade after rocuronium.

IMPLICATIONS: We present a novel site of monitoring neuromuscular blockade of the diaphragm at the patient’s back, which shows good agreement with the conventional anterior site at the seventh or eighth intercostal space.

This article has been cited by other articles:

				T. M. Hemmerling and N. Le Brief review: Neuromuscular monitoring: an update for the clinician: [Article de synthese court : Monitorage neuromusculaire : une mise a jour pour le clinicien] Can J Anesth, January 1, 2007; 54(1): 58 - 72. [Abstract] [Full Text] [PDF]

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