Advertisement

Recovery from rocuronium-induced neuromuscular block was longer in the larynx than in the pelvic limb of anesthetized dogs

Published:January 07, 2017DOI:https://doi.org/10.1016/j.vaa.2016.04.001

      Abstract

      Objective

      To determine if neuromuscular monitoring at the pelvic limb accurately reflects neuromuscular function in the larynx after administration of rocuronium in anesthetized dogs.

      Study design

      Prospective experimental study.

      Animals

      Six healthy Beagle dogs.

      Methods

      Anesthesia was maintained in dogs with isoflurane and a continuous infusion of dexmedetomidine. Rocuronium (0.6 mg kg−1) was administered intravenously to induce neuromuscular block. Train-of-four (TOF) impulses were applied to the left recurrent laryngeal nerve (RLn) and the peroneal nerve (Pn). The evoked TOF ratio (TOFR; T4:T1) was measured with electromyography (EMG) simultaneously at the larynx and at the pelvic limb. Spontaneous recoveries of T1 to 25% (T125%) and 75% (T175%) of twitch height, and to TOFR of 0.70 and 0.90 (TOFR0.90) at each EMG site were compared.

      Results

      Data from five dogs were analyzed. Times to T125% were similar at the pelvic limb and larynx when measured by EMG; time to T175% was slower at the larynx by 6 ± 4 minutes (p = 0.012). The larynx had a slower recovery to TOFR0.70 (41 ± 13 minutes) and TOFR0.90 (45 ± 13 minutes) than did the pelvic limb [29 ± 8 minutes (p = 0.011) and 33 ± 9 minutes (p = 0.003), respectively]. When the pelvic limb EMG returned to TOFR0.70 and TOFR0.90, the larynx EMG TOFR0.70 and TOFR0.90 values were 0.32 ± 0.12 (p = 0.001) and 0.38 ± 0.13 (p = 0.001), respectively.

      Conclusions and clinical relevance

      After administration of rocuronium, neuromuscular function assessed by EMG recovered approximately 36% slower at the larynx than at the pelvic limb. The results in these dogs suggest that quantitative neuromuscular monitoring instrumented at a pelvic limb may be unable to exclude residual block at the larynx in anesthetized dogs.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Veterinary Anaesthesia and Analgesia
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • acvaa.org
        Small Animal monitoring guidelines.
        (Available from: http://acvaa.org/docs/Small_Animal_Monitoring_2009.doc)
        Date: 2009
        (Last accessed 19 June 2015)
        • Bigland B.
        • Goetzee B.
        • Maclagan J.
        • Zaimis E.
        The effect of lowered muscle temperature on the action of neuromuscular blocking drugs.
        J Physiol. 1958; 141: 425-434
        • Capron F.
        • Alla F.
        • Hottier C.
        • et al.
        Can acceleromyography detect low levels of residual paralysis? A probability approach to detect a mechanomyographic train-of-four ratio of 0.9.
        Anesthesiology. 2004; 100: 1119-1124
        • Eikermann M.
        • Groeben H.
        • Hüsing J.
        • Peters J.
        Accelerometry of adductor pollicis muscle predicts recovery of respiratory function from neuromuscular blockade.
        Anesthesiology. 2003; 98: 1333-1337
        • Eikermann M.
        • Vogt F.M.
        • Herbstreit F.
        • et al.
        The predisposition to inspiratory upper airway collapse during partial neuromuscular blockade.
        Am J Respir Crit Care Med. 2007; 175: 9-15
        • Eriksson L.I.
        • Sundman E.
        • Olsson R.
        • et al.
        Functional assessment of the pharynx at rest and during swallowing in partially paralyzed humans: simultaneous videomanometry and mechanomyography of awake human volunteers.
        Anesthesiology. 1997; 87: 1035-1043
        • Fuchs-Buder T.
        • Claudius C.
        • Skovgaard L.T.
        • et al.
        Good clinical research practice in pharmacodynamic studies of neuromuscular blocking agents II: the Stockholm revision.
        Acta Anaesthesiol Scand. 2007; 51: 789-808
        • Heier T.
        • Caldwell J.E.
        • Feiner J.R.
        • et al.
        Relationship between normalized adductor pollicis train-of-four ratio and manifestations of residual neuromuscular block: a study using acceleromyography during near steady-state concentrations of mivacurium.
        Anesthesiology. 2010; 113: 825-832
        • Hemmerling T.M.
        • Schmidt J.
        • Hanusa C.
        • et al.
        Simultaneous determination of neuromuscular block at the larynx, diaphragm, adductor pollicis, orbicularis oculi and corrugator supercilii muscles.
        Br J Anaesth. 2000; 85: 856-860
        • Ibebunjo C.
        • Hall L.W.
        Succinylcholine and vecuronium blockade of the diaphragm, laryngeal and limb muscles in the anaesthetized goat.
        Can J Anaesth. 1994; 41: 36-42
        • Ibebunjo C.
        • Srikant C.B.
        • Donati F.
        Duration of succinylcholine and vecuronium blockade but not potency correlates with the ratio of endplate size to fibre size in seven muscles in the goat.
        Can J Anaesth. 1996; 43: 485-494
        • Iwasaki H.
        • Igarashi M.
        • Namiki A.
        • Omote K.
        Differential neuromuscular effects of vecuronium on the adductor and abductor laryngeal muscles and tibialis anterior muscle in dogs.
        Br J Anaesth. 1994; 72: 321-323
        • Kirov K.
        • Motamed C.
        • Decailliot F.
        • et al.
        Comparison of the neuromuscular blocking effect of cisatracurium and atracurium on the larynx and the adductor pollicis.
        Acta Anaesthesiol Scand. 2004; 48: 577-581
        • Kopman A.F.
        • Yee P.S.
        • Neuman G.G.
        Relationship of the train-of-four fade ratio to clinical signs and symptoms of residual paralysis in awake volunteers.
        Anesthesiology. 1997; 86: 765-771
        • Michalek-Sauberer A.
        • Gilly H.
        • Steinbereithner K.
        • et al.
        Effects of vecuronium and rocuronium in antagonistic laryngeal muscles and the anterior tibial muscle in the cat.
        Acta Anaesthesiol Scand. 2000; 44: 503-510
        • Mortensen C.R.
        • Berg H.
        • el-Mahdy A.
        • Viby-Mogensen J.
        Perioperative monitoring of neuromuscular transmission using acceleromyography prevents residual neuromuscular block following pancuronium.
        Acta Anaesthesiol Scand. 1995; 39: 797-801
        • Murphy G.S.
        • Brull S.J.
        Residual neuromuscular block: lessons unlearned. Part I: definitions, incidence, and adverse physiologic effects of residual neuromuscular block.
        Anesth Analg. 2010; 111: 120-128
        • Murphy G.S.
        • Szokol J.W.
        • Marymont J.H.
        • et al.
        Residual neuromuscular blockade and critical respiratory events in the postanesthesia care unit.
        Anesth Analg. 2008; 107: 130-137
        • Murphy G.S.
        • Szokol J.W.
        • Marymont J.H.
        • et al.
        Intraoperative acceleromyographic monitoring reduces the risk of residual neuromuscular blockade and adverse respiratory events in the postanesthesia care unit.
        Anesthesiology. 2008; 109: 389-398
        • Piccioni F.
        • Mariani L.
        • Bogno L.
        • et al.
        An acceleromyographic train-of-four ratio of 1.0 reliably excludes respiratory muscle weakness after major abdominal surgery: a randomized double-blind study.
        Can J Anaesth. 2014; 61: 641-649
        • Plaud B.
        • Proost J.H.
        • Wierda J.M.
        • et al.
        Pharmacokinetics and pharmacodynamics of rocuronium at the vocal cords and the adductor pollicis in humans.
        Clin Pharmacol Ther. 1995; 58: 185-191
        • Sakai D.M.
        • Martin-Flores M.
        • Tomak E.A.
        • et al.
        Differences between acceleromyography and electromyography during neuromuscular function monitoring in anesthetized Beagle dogs.
        Vet Anaesth Analg. 2015; 42: 233-241
        • Sundman E.
        • Witt H.
        • Olsson R.
        • et al.
        The incidence and mechanisms of pharyngeal and upper esophageal dysfunction in partially paralyzed humans: pharyngeal videoradiography and simultaneous manometry after atracurium.
        Anesthesiology. 2000; 92: 977-984
        • Viby-Mogensen J.
        • Jørgensen B.C.
        • Ording H.
        Residual curarization in the recovery room.
        Anesthesiology. 1979; 50: 539-541