Assessment of neuromuscular block at the thumb and great toe using accelography in infants

1365-2044

Blackwell Publishing Journal Backfiles 1879-2005

Medicine

We assessed neuromuscular block at the thumb and great toe using accelography after the administration of vecuronium in infants. Train-of-four stimuli were simultaneously applied to the ulnar and tibial nerves using cutaneous electrodes. Anaesthesia was maintained with nitrous oxide (66%) in oxygen and sevoflurane (1%). Vecuronium 0.1mg.kg-1 was used for paralysis and reversed with intravenous neostigmine 0.04mg.kg-1 with atropine 0.02mg.kg-1 when the train-of-four ratio on the right great toe returned to 25%. The mean (SD) times from initial administration of vecuronium to completion of maximal block on the thumb and great toe were 78 (21.1) s and 75 (14.3) s, respectively (p〉0.05). The times from maximal block to 25% recovery of twitch height at the thumb and great toe were 46 (9.1) min and 45 (9.0) min, respectively. The reversal time from 25% to 75% of the train-of-four ratio after the administration of neostigmine was 136 (49.1)s. We conclude that neuromuscular monitoring of the great toe in infants may be a suitable alternative when the thumb is inaccessible.

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