Neuromuscular monitoring [Neuromuskuläres Monitoring]

被引：1
作者：
Mencke T. [1 ]
Schmartz D. [2 ]
Fuchs-Buder T. [2 ]
机构：
[1] Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Universitätsmedizin Rostock, Rostock
[2] Département d'Anesthésie-Réanimation, Centre Hopitalier Universitaire de Nancy, Hopitaux de Brabois 4, Rue du Morvan
来源：
Der Anaesthesist | 2013年 / 62卷 / 10期
关键词：
Anesthesia recovery period; Electrical stimulation; Myography; Neuromuscular blockade; Train of four monitoring;
D O I：
10.1007/s00101-013-2244-0
中图分类号：
学科分类号：
摘要：
The effect of muscle relaxants varies among people and the extent, the duration and recovery from the neuromuscular block varies. Clinical tests cannot determine the effect of muscle relaxants which is only possible with neuromuscular monitoring. The relaxometry procedure measures the muscular response to electrical stimulation of the corresponding motor nerve and the adductor pollicis muscle is mostly used; however, this muscle is not representative for other muscle groups, such as the muscles of the larynx and diaphragm. The muscles of the larynx and diaphragm are more resistant against nondepolarizing muscle relaxants than the adductor pollicis muscle. The train of four (TOF) is used at the beginning of surgery for monitoring of the optimal time for tracheal intubation; moreover, the TOF is used during surgery for monitoring of the muscle blockade and at the end of surgery for monitoring recovery. Monitoring of deep muscular blockades, however, is only possible with the posttetanic count (PTC) when there are no TOF counts. The PTC allows repetition and higher doses of muscle relaxants during abdominal surgery; therefore, conditions for surgery are optimal and cumulation of muscle relaxants is avoided. © 2013 Springer-Verlag Berlin Heidelberg.
引用
收藏
页码：847 / 861
页数：14
相关论文
共 10 条
  • [1] Katz, R.L., Neuromuscular effects of d-tubocurarine, edrophonium and neostigmine in man (1967) Anesthesiology, 28, pp. 327-336
  • [2] Maybauer, D.M., Geldner, G., Blobner, M., Incidence and duration of residual paralysis at the end of surgery after multiple administrations of cisatracurium and rocuronium (2007) Anaesthesia, 62, pp. 12-17
  • [3] Baillard, C., Clec'H, C., Catineau, J., Postoperative neuromuscular block: A survey of management (2005) Br J Anaesth, 95, pp. 622-626
  • [4] Brull, S.J., Silverman, D.G., Pulse width, stimulus intensity, electrode placement and polarity during assessment of neuromuscular block (1995) Anesthesiology, 83, pp. 702-709
  • [5] Fuchs-Buder, T., Schreiber, J.-U., Meistelman, C., Monitoring neuromuscular block: An update (2009) Anaesthesia, 64, pp. 82-89
  • [6] Fuchs-Buder, T., Grundlagen des neuromuskulären Monitorings (2008) Neuromuskuläres Monitoring in Klinik und Forschung, pp. 26-76. , Fuchs-Buder T (Hrsg). Springer, Berlin Heidelberg New York Tokio
  • [7] Fuchs-Buder, T., Claudius, C., Skovgaard, L.T., Good clinical research practice in pharmacodynamic studies of neuromuscular blocking agents II: The Stockholm revision (2007) Acta Anaesthesiol Scand, 51, pp. 789-808
  • [8] Capron, F., Alla, F., Hottier, C., Can acceleromyography detect low degrees of residual paralysis? A probability approach to detect a mechanomyographic train-of-four ratio of 0.9 (2004) Anesthesiology, 100, pp. 1119-1124
  • [9] Samet, A., Capron, F., Alla, F., Single accelerometric train-of-four, 100-Hertz tetanus or double-burst-stimulation: Which test performs better to detect residual paralysis? (2005) Anethesiology, 102, pp. 51-56
  • [10] Schreiber, J.U., Mucha, E., Fuchs-Buder, T., Acceleromyography to assess neuromuscular recovery: Is calibration before measurement mandatory? (2011) Acta Anaesthesiol Scand, 55, pp. 328-331
1