Larsen P B, Gätke M R, Fredensborg B B, Berg H, Engbaek J, Viby-Mogensen J
Department of Anesthesiology, Herlev Hospital, University of Copenhagen, Herlev, Denmark.
Acta Anaesthesiol Scand. 2002 Oct;46(9):1131-6. doi: 10.1034/j.1399-6576.2002.460912.x.
The orbicularis oculi (OO) muscle has been recommended for neuromuscular monitoring when the adductor pollicis (AP) muscle is not available. We investigated whether neuromuscular block could be measured reliably from the orbital part of the OO muscle by the use of acceleromyography.
During propofol, fentanyl, and alfentanil anaesthesia two TOF-Guards (Organon Teknika NV, Boxtel, the Netherlands) with acceleration transducers placed on the distal phalanx of the thumb and over the middle of the eyebrow, respectively, were used to measure neuromuscular block simultaneously in 23 patients during vecuronium-induced and neostigmine-antagonized neuromuscular block. For both muscles, the simultaneously recorded first response (T1) in the train-of-four (TOF) and TOF-ratio were measured both during onset and recovery of the block. Furthermore, both the AP muscle T1 and TOF-ratio responses were plotted against 10% intervals of the OO muscle responses during onset and recovery, respectively.
The orbicularis oculi muscle had a shorter latency and a faster recovery to TOF-ratio 0.80 compared with the AP muscle. During onset and recovery, pronounced variations of the AP muscle T1 and TOF-ratio responses were observed when compared with the OO muscle.
A significant clinical disagreement exists between the degree of paralysis measured at the OO and the AP muscles. It is impossible to obtain a reasonable estimate of the degree of block at the AP muscle when the block is measured from the OO muscle with acceleromyography. If used, there is substantial risk of overlooking a residual block, and adequate recovery of the block should be confirmed by a final AP muscle measurement.
当无法使用拇内收肌（AP）时，推荐使用眼轮匝肌（OO）进行神经肌肉监测。我们研究了通过加速度肌电图是否能可靠地测量OO肌眼眶部分的神经肌肉阻滞。
在丙泊酚、芬太尼和阿芬太尼麻醉期间，分别将两个带有加速度传感器的TOF监护仪（Organon Teknika NV，荷兰博克斯泰尔）放置在拇指远端指骨和眉中部，用于在23例患者维库溴铵诱导和新斯的明拮抗神经肌肉阻滞期间同时测量神经肌肉阻滞。对于这两块肌肉，在阻滞起效和恢复期间测量四个成串刺激（TOF）中同时记录的第一个反应（T1）和TOF比值。此外，分别在阻滞起效和恢复期间，将AP肌的T1和TOF比值反应与OO肌反应的10%间隔进行绘制。
与AP肌相比，眼轮匝肌的潜伏期更短，恢复到TOF比值0.80的速度更快。在起效和恢复期间，与OO肌相比，观察到AP肌的T1和TOF比值反应有明显变化。
在OO肌和AP肌测量的麻痹程度之间存在明显的临床差异。当用加速度肌电图从OO肌测量阻滞时，不可能合理估计AP肌的阻滞程度。如果使用，存在忽视残余阻滞的重大风险，并且应通过最终的AP肌测量来确认阻滞的充分恢复。
