Electromyographic monitoring of profound surgical muscle relaxation during cardiac anesthesia

Abstract

Quantitative assessment of neuromuscular block produced by large doses of nondepolarizing neuromuscular blocking agents during cardiac surgery is not possible with conventional methods of monitoring. Various "posttetanic responses" can, however, be elicited, even when no twitch response is present. Posttetanic responses measured by electromyography were used in this study. Twenty-four male patients undergoing coronary bypass surgery were anesthetized with sufentanil plus diazepam. Neuromuscular block was provided either with pancuronium 0.1 mg/kg or with vecuronium 0.07 mg/kg initially and supplemented with small increments when indicated. Neuromuscular block was monitored from the hypothenar muscle. The ulnar nerve was stimulated by train-of-four, with superimposed periodic tetanic stimuli to evoke posttetanic responses, once every 7 to 15 minutes. The tetanically potentiated responses were detectable during 96% +/- 3.6 (vecuronium) and during 97% +/- 3.7 (pancuronium) of the entire intraoperative period, while the non-potentiated electromyographic responses were present for less than 50% of the time. The sum (of the amplitudes) of 6 posttetanic responses is significantly (p less than 0.05) greater than the sum of 6 nonpotentiated responses and than the size of a single-peak posttetanic response when compared with the normal, nonpotentiated responses. Higher-frequency tetanic stimuli (100 or 200 Hz) produced greater posttetanic responses (p less than 0.05) than did the 50-Hz tetanic stimulus. There were only slight or no significant differences in the degree of posttetanic potentiation between pancuronium and vecuronium either before, during, or after cardiopulmonary bypass.(ABSTRACT TRUNCATED AT 250 WORDS)