Tactile evaluation of fade of the train-of-four and double-burst stimulation using the anaesthetist's non-dominant hand

Abstract

We have studied detection of fade in response to train-of-four (TOF), double-burst stimulation3,3 (DBS3,3) or DBS3,2, assessed tactilely by the anaesthetist using the index finger of the non-dominant hand and the thumb of the patient, compared with that assessed when the index finger of the dominant hand was used. The probability of detection of any fade in response to TOF or DBS3,3 using the non-dominant hand was significantly less than when the dominant hand was used (P < 0.05). The probability of identification of fade in response to DBS3,2 assessed using the non-dominant hand was comparable with that evaluated using the dominant hand when TOF ratios were 0-0.9, but when TOF ratios reached 0.91-1.00, detection using the non-dominant hand was significantly less common than with the dominant hand (12% vs 33%; P < 0.05). Using the non-dominant hand, the probability of detection of fade in response to ulnar nerve stimulation was less than that with the dominant hand and only the absence of DBS3,2 fade ensured sufficient recovery of neuromuscular block.