The effect of single twitch and train-of-four stimulation on twitch forces during stable neuromuscular block

Abstract

Objective: We investigated whether the response to a single twitch (ST) stimulus or the first response (T1) to a train-of-four (TOF; 4 stimuli at 2 Hz) stimulus following a stimulus interval of 10 s (i.e., the time between two consecutive ST or TOF stimuli) is influenced by the preceding stimulus in the presence of a stable 50% neuromuscular block. In addition, we determined whether ST and TOF stimulation yield different results under these circumstances.

Methods: Twitch forces were measured in both tibialis anterior muscles of six cats. In the presence of a stable 50% neuromuscular block the stimulation pattern (ST or TOF) or stimulus interval (3.3, 10 or 30 s) was varied every 30 min. A linear mixed model was used for statistical analysis.

Results: ST forces with a stimulus interval of 3.3 s were 10.3% (95% CI: 7.3-13.3%) smaller than those with a stimulus interval of 10 s. For T1 forces this effect was 15.2% (95% CI: 12-18.4%). There was no significant difference between twitch forces with stimulus intervals of 30 and 10 s. For a stimulus interval of 3.3 s the ST forces exceeded the T1 forces by 7.6% (95% CI: 4.4-10.8%); no significant differences were found between the ST and T1 forces for stimulus intervals of 10 and 30 s.

Conclusions: The ST or T1 force during stimulation with a stimulus interval of 10 s or more during a stable 50% neuromuscular block in the tibialis anterior muscle of the cat is not affected by the preceding stimulus. In addition, ST and T1 forces do not differ when employing a stimulus interval of 10 s or more under these circumstances. Our results thus indicate that the known differences between ST and T1 forces after a bolus injection of a muscle relaxant can not be explained by differences in acetylcholine release when the stimulus interval exceeds 10 s.