Abstract
Purpose
Phonomyography (PMG) is a novel technique for measuring neuromuscular blockade (NMB). The effect of the duration of control stimulation on the onset and duration of blockade was investigated using PMG and acceleromyography (AMG).
Methods
After induction of anesthesia, a microphone was placed above the middle portion of the left eyebrow, and an acceleromyo-graphic probe was placed above the middle portion of the right eyebrow. Twenty patients were randomized to receive bilateral, single-twitch, facial nerve stimulation (0.1 Hz, 20 mA) with three minutes (n = 10) or ten minutes (n = 10) of supramaximal stimulation before mivacurium 0.2 mg·kg−1 was administered. Onset, maximum effect, and offset of NMB were measured.
Results
Using PMG, lag time, onset time, maximum effect, and time to reach 75% of control twitch height (mean ± SD) were 36 ± 27 sec, 136 ± 35 sec, 89 ± 10%, and 12.1 ± 4.5 min, respectively, after three minutes of control stimulation and were 40 ± 22 sec, 122 ± 40 sec, 93 ± 3%, and 12.4 ± 4.9 min, after ten minutes. Using AMG, the values were 38 ± 23 sec, 106 ± 28 sec, 79 ± 6%, and 14.3 ± 5.9 min, respectively, after three minutes and were 34 ± 22 sec, 106 ± 28 sec, 76 ± 10%, and 14.9 ± 3.7 min, after ten minutes. Compared to PMG, AMG revealed significant bias for onset time (−30 sec), maximum effect (−16%) and time to reach 75% of control twitch height (1.5 min), with wide limits of agreement of 66 sec, 22%, and 5.6 min, respectively.
Conclusion
The duration of control stimulation did not influence the time course of blockade measured by either method. Three minutes of supramaximal stimulation is sufficient to measure pharmacodynamic parameters. AMG measures a shorter onset and longer recovery time and reduced anesthesiology the maximum effect compared to PMG.
Résumé
Objectif
La phonomyographie (PMG) est une nouvelle technique de mesure du blocage neuromusculaire (BNM). L’effet de la durée de la stimulation contrôlée sur le délai d’installation et la durée du blocage neuromusculaire a été vérifiée en utilisant la PMG et l’accéléromyographie (AMG).
Méthode
Après l’induction de l’anesthésie, un microphone a été placée au-dessus de la partie médiane du sourcil gauche et une sonde accéléromyographique a été placée au-dessus de la partie médiane du sourcil droit. Vingt patients ont été répartis au hasard pour recevoir une stimulation simple bilatérale du nerf facial (0,1 Hz, 20 mA) et trois minutes (n = 10) ou dix minutes (n = 10) de stimulation supramaximale avec l’administration de 0,2 mg·kg−1 de mivacurium. Le délai d’installation, l’effet maximal et la fin du BNM ont été enregistrés.
Résultats
Avec la PMG, la période de latence, le début, l’effet maximal et le temps nécessaire pour atteindre 75 % de la de la stimulation contrôlée (moyenne ± écart type) ont été de 36 ± 27 sec, 136 ± 35 sec, 89 ± 10 % et de 12,1 ± 4,5 min, respectivement après trois minutes de stimulation contrôlée et de 40 ± 22 sec, I22± 40 sec, 93 ± 3 % et 12,4 ± 4,9 min après dix minutes. Avec l’AMG, les valeurs ont été de 38 ± 23 sec, 106 ±28 sec, 79 ± 6 % et de 14,3 ± 5,9 min, respectivement après trois minutes et de 34 ± 22 sec, 106 ± 28 sec, 76 ± 10 % et de 14,9 ± 3,7 min après dix minutes. Comparée à la PMG, l’AMG a révélé un biais signifcatif pour le moment du début (−30 sec), l’effet maximal (−16%) et le temps d’atteindre 75 % de la stimulation contrôlée (1,5 min) avec de grandes limites de concordance de 66 sec, 22 % et 5,6 min respectivement.
Conclusion
La durée de la stimulation contrôlée n’influence pas l’évolution du blocage mesuré selon l’une ou l’autre méthode. Trois minutes de stimulation supramaximale suffisent pour mesurer les paramètres pharmacodynamiques. L’AMG, comparée à la PMG, mesure un délai d’installation plus court et un temps de récupération plus long et réduit l’effet maximal.
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Hemmerling, T.M., Donati, F., Babin, D. et al. Duration of control stimulation does not affect onset and offset of neuromuscular blockade at the corrugator supercilii muscle measured with phonomyography or acceleromyography. Can J Anesth 49, 913–917 (2002). https://doi.org/10.1007/BF03016873
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DOI: https://doi.org/10.1007/BF03016873