Gyermek L
Department of Anesthesiology, Harbor-UCLA Medical Center, Torrance 90509.
J Clin Anesth. 1990 May-Jun;2(3):152-7. doi: 10.1016/0952-8180(90)90089-l.
The assessment of deep neuromuscular blockade produced by nondepolarizing neuromuscular blocking agents is not possible with the conventional use of the Datex NMT-221 "relaxograph" (Datex NMT-221 monitor, Datex Instrumentarium, Helsinki, Finland), an otherwise useful electromyographic (EMG) monitoring device. A method whereby the relaxograph can be adapted to quantitatively measure posttetanic responses is described here. In anesthetized adult patients, neuromuscular blockade was monitored simultaneously on both hands with two relaxographs. On one hand, EMG responses of hypothenar muscles to the built-in 1/20-second sequence of train-of-four stimuli of the monitor were used. On the other hand, similar recordings were made with the addition of periodically superimposed supramaximal tetanic stimuli of 100 Hz to the ulnar nerve. Neuromuscular block was provided with pancuronium. The time courses of the spontaneous recovery of the first of the train-of-four EMG responses were compared in the stimulated and control arms. At the end of the surgery, the neuromuscular block was pharmacologically reversed with atropine and neostigmine. If no tetanic stimuli were applied, the EMG responses were identical in both arms during the spontaneous recovery from the neuromuscular blockade. If tetanic stimuli were applied every 4 or 7 minutes, the rate of recovery in the stimulated hand usually exceeded that of the control hand. However, no significant difference was observed in the recovery rate when the tetanic stimuli were spaced at 15-minute intervals. Pharmacologic reversal by atropine and neostigmine was found to be identical in all patient groups. The author concludes that the Datex relaxograph is suitable for the quantitative assessment of profound surgical neuromuscular blockade with the described modification.
使用常规的Datex NMT - 221“松弛图仪”（Datex NMT - 221监测仪，芬兰赫尔辛基Datex仪器公司）无法评估非去极化神经肌肉阻滞剂产生的深度神经肌肉阻滞，而该仪器在其他方面是一种有用的肌电图（EMG）监测设备。本文描述了一种使松弛图仪能够适用于定量测量强直后反应的方法。在成年麻醉患者中，用两台松弛图仪同时监测双手的神经肌肉阻滞情况。一只手使用小鱼际肌对监测仪内置的1/20秒四个成串刺激序列的EMG反应。另一只手则在对尺神经施加100Hz的周期性叠加超强强直刺激的情况下进行类似记录。使用泮库溴铵产生神经肌肉阻滞。比较受刺激侧和对照侧四个成串EMG反应中第一个反应的自发恢复时间进程。手术结束时，用阿托品和新斯的明进行药理学逆转神经肌肉阻滞。如果不施加强直刺激，在从神经肌肉阻滞中自发恢复期间，两侧的EMG反应相同。如果每4或7分钟施加一次强直刺激，受刺激手的恢复速度通常超过对照手。然而，当强直刺激间隔15分钟时，未观察到恢复速度有显著差异。发现阿托品和新斯的明对所有患者组的药理学逆转作用相同。作者得出结论，经所述改进后，Datex松弛图仪适用于对深度外科手术神经肌肉阻滞进行定量评估。
