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ANESTHETIC PHARMACOLOGY

The Relationship of Posttetanic Count and Train-of-Four Responses During Recovery from Intense Cisatracurium-Induced Neuromuscular Blockade

Mohammad I. El-Orbany, MD^*, Ninos J. Joseph, BS^*, and M. Ramez Salem, MD^*,

Department of Anesthesiology, *Advocate Illinois Masonic Medical Center, and University of Illinois College of Medicine, Chicago, Illinois

Address correspondence and reprint requests to Mohammad I. El-Orbany, MD, Department of Anesthesiology, Advocate Illinois Masonic Medical Center, 836 W. Wellington Ave., Chicago, IL 60657. Address e-mail to mohammad.el-orbany-md{at}advocatehealth.com

Posttetanic count (PTC) has been used to quantify intense degrees of nondepolarizing neuromuscular blockade. Our objective in the present investigation was to discern whether PTC correlates with recovery from intense cisatracurium-induced neuromuscular blockade under both inhaled and IV anesthesia. In 60 patients, anesthesia was induced with propofol 2 mg/kg and fentanyl 1.5 µg/kg IV. Recovery from intense neuromuscular blockade induced by cisatracurium (0.15 mg/kg) was studied in 2 groups. Group 1 (n = 30) had anesthesia maintained with propofol 100–200 µg · kg^-1 · min^-1 and 60% N₂O in O₂, whereas Group 2 (n = 30) had anesthesia maintained with isoflurane (end-tidal concentration 0.8%) and 60% N₂O in O₂. Neuromuscular functions were monitored using acceleromyography. Cycles of posttetanic stimulation were repeated every 6 min with train-of-four (TOF) stimulation in between. Measurement included times to posttetanic responses and to the first response to TOF stimulation (T₁), as well as the correlation between PTC and T₁. In Group 1, the mean times to PTC₁ and T₁ were 35.6 ± 7.5 and 46.9 ± 6.5 min, respectively. Corresponding times in Group 2 were 39.5 ± 6.8 and 56.7 ± 5.4 min, respectively. There was a good time correlation, r = 0.919 for propofol (Group 1) and r = 0.779 for isoflurane (Group 2), between PTC and T₁ recovery in both groups. The PTC when T₁ appeared ranged between 8 and 9 in Group 1 and 8 and 14 in Group 2. Conforming to original observations with other neuromuscular blocking drugs, there is a correlation between PTC and TOF recovery from intense cisatracurium-induced neuromuscular blockade allowing better monitoring of this intense degree of blockade during both IV (propofol) and isoflurane anesthesia.

IMPLICATIONS: Monitoring posttetanic count during intense neuromuscular blockade allows the clinician to estimate the intensity of the blockade and estimate recovery time. The relationship between posttetanic count and train-of-four recovery from intense cisatracurium-induced neuromuscular blockade was documented under both IV and inhaled anesthesia.

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