Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
Kaohsiung J Med Sci. 2010 Dec;26(12):640-6. doi: 10.1016/S1607-551X(10)70098-X.
Neuromuscular blocking agents (NMBAs) might diminish the electromyography signal of the vocalis muscles during intraoperative neuromonitoring of the recurrent laryngeal nerve. The aim of this study was to compare differential sensitivity of different muscles to succinylcholine in a swine model, and to realize the influence of NMBAs on neuromonitoring. Six male Duroc-Landrace piglets were anesthetized with thiamylal and underwent tracheal intubation without the use of an NMBA. The left recurrent laryngeal nerve, the spinal accessory nerve, the right phrenic nerve and the brachial plexus were stimulated. Evoked potentials (electromyography signal) of four muscle groups were elicited from needle electrodes before and after intravenous succinylcholine bolus (1.0 mg/kg). Recorded muscles included the vocalis muscles, trapezius muscle, diaphragm and triceps brachii muscles. The onset time and 80% recovery of control response were recorded and analyzed. The testing was repeated after 30 minutes. The onset time of neuromuscular blocking for the vocalis muscles, trapezius muscle, diaphragm and triceps brachii muscle was 36.3 ± 6.3 seconds, 38.8 ± 14.9 seconds, 52.5 ± 9.7 seconds and 45.0 ± 8.2 seconds during the first test; and 49.3 ± 10.8 seconds, 40.0 ± 12.2 seconds, 47.5 ± 11.9 seconds and 41.3 ± 10.1 seconds during the second test. The 80% recovery of the control response for each muscle was 18.3 ± 2.7 minutes, 16.5±6.9 minutes, 8.1±2.5 minutes and 14.8±2.9 minutes during the first test; and 21.5±3.8 minutes, 12.5 ± 4.3 minutes, 10.5 ± 3.1 minutes and 16.4 ± 4.2 minutes during the second test. The sensitivity of the muscles to succinylcholine, ranked in order, was: the vocalis muscles, the triceps brachii muscle, the trapezius muscle and the diaphragm. We demonstrated a useful and reliable animal model to investigate the effects of NMBAs on intraoperative neuromonitoring. Extrapolation of these data to humans should be done with caution.
神经肌肉阻断剂（NMBAs）可能会降低喉返神经术中神经监测时的声带肌肌电图信号。本研究旨在比较不同肌肉对琥珀酰胆碱的差异敏感性，并了解 NMBA 对神经监测的影响。六只雄性杜洛克-长白猪用硫喷妥钠麻醉，并在不使用 NMBA 的情况下进行气管插管。刺激左侧喉返神经、副神经、右侧膈神经和臂丛。在静脉推注琥珀酰胆碱（1.0mg/kg）前后，通过针电极引出 4 组肌肉的诱发电位（肌电图信号）。记录的肌肉包括声带肌、斜方肌、膈肌和肱三头肌。记录并分析了对照反应的起始时间和 80%恢复时间。30 分钟后重复测试。第一次测试时，声带肌、斜方肌、膈肌和肱三头肌的神经肌肉阻滞起始时间分别为 36.3 ± 6.3 秒、38.8 ± 14.9 秒、52.5 ± 9.7 秒和 45.0 ± 8.2 秒；第二次测试时，分别为 49.3 ± 10.8 秒、40.0 ± 12.2 秒、47.5 ± 11.9 秒和 41.3 ± 10.1 秒。每种肌肉的对照反应 80%恢复时间分别为 18.3 ± 2.7 分钟、16.5 ± 6.9 分钟、8.1 ± 2.5 分钟和 14.8 ± 2.9 分钟；第二次测试时，分别为 21.5 ± 3.8 分钟、12.5 ± 4.3 分钟、10.5 ± 3.1 分钟和 16.4 ± 4.2 分钟。肌肉对琥珀酰胆碱的敏感性依次为：声带肌、肱三头肌、斜方肌和膈肌。我们证明了一种有用且可靠的动物模型，可用于研究 NMBA 对术中神经监测的影响。这些数据的外推应谨慎进行。
