Monitoring of vecuronium-induced neuromuscular block at the sternocleidomastoid muscle in anesthetized patients.

摘要

PURPOSE: To assess the degree of neuromuscular block acceleromyographically at the sternocleidomastoid muscle. METHODS: Eighteen adult patients scheduled for air-oxygen-sevoflurane-fentanyl and epidural anesthesia were studied. In the patients, the right accessory nerve and the sternocleidomastoid muscle were stimulated and the contraction of the sternocleidomastoid muscle was evaluated acceleromyographically. Simultaneously, the response of the adductor pollicis muscle was measured electromyographically. Supramaximal stimulating current, degree of maximum neuromuscular block after vecuronium 0.1 mg/kg, and onset of or recovery from vecuronium-induced neuromuscular block were compared between the two muscles. RESULTS: The supramaximal stimulating current at the sternocleidomastoid muscle was significantly higher than that at the adductor pollicis muscle (54.8 +/- 7.1 vs. 33.7 +/- 10.3 mA, mean +/- SD, P < 0.001). The onset of neuromuscular block at the sternocleidomastoid muscle did not significantly differ from that at the adductor pollicis muscle (214 +/- 117 vs. 161 +/- 87 s, P = 0.131). The degree of maximum neuromuscular block at the sternocleidomastoid muscle was significantly less than that at the adductor pollicis muscle (93.6 +/- 3.1 vs. 99.2 +/- 2.5%, P < 0.001). During recovery from neuromuscular block, T1/control and train-of-four ratio measured at the sternocleidomastoid muscle were significantly higher than those at the adductor pollicis muscle 10-30 and 40-120 min after vecuronium, respectively (P < 0.05). CONCLUSION: The sternocleidomastoid muscle is more resistant to vecuronium than the adductor pollicis muscle. Recovery from neuromuscular block is faster at the sternocleidomastoid muscle than at the adductor pollicis muscle.