Gi Year Lee1, Sooyoung Cho2,3, Hee Jung Baik1,4, Jong Wha Lee1,4, Jae Hee Woo4,5, Hyun Jung Lee4,5, Seung Hee Yoo1,4. 1. Department of Anesthesiology and Pain Medicine, Ewha Womans University Medical Center Mokdong Hospital, Seoul, Republic of Korea. 2. Department of Anesthesiology and Pain Medicine, Ewha Womans University Medical Center Mokdong Hospital, Seoul, Republic of Korea. sooyoung.cho@ewha.ac.kr. 3. Department of Anesthesiology and Pain Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea. sooyoung.cho@ewha.ac.kr. 4. Department of Anesthesiology and Pain Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea. 5. Department of Anesthesiology and Pain Medicine, Ewha Womans University Medical Center Seoul Hospital, Seoul, Republic of Korea.
Abstract
PURPOSE: The supramaximal stimulation (SMS) of the TOF test causes uncomfortable sensations in patients. We aimed to determine whether the submaximal stimulation would be reliable in TOF tests with reduced painful sensation. METHODS: The accelomyography (AMG) and electromyography (EMG) monitor was applied at each arm and general anesthesia was induced and maintained by total intravenous anesthesia. At extubation, we conducted TOF test three times at each of four different currents: SMS, 70% SMS, 50% SMS, and 30% SMS. The same procedure was performed in the postanesthesia care unit (PACU) only with EMG, and the pain scores on the numerical rating scale (NRS) during the tests were recorded. RESULTS: A total of 36 patients were enrolled. At extubation, TOF ratios with SMS in AMG and EMG were 112.0 ± 13.1% and 93.7 ± 8.9%, respectively. There were no significant differences in TOF ratios between the SMS and lower stimulation intensities. However, 30% and 50% SMS showed significantly higher rates of the unmeasurable results of tests in the PACU. In terms of the stimulation pain, NRS showed a downward pattern as the current decreased and was significantly lower at 50% and 30% SMS than the NRS at SMS. CONCLUSION: The TOF test with submaximal stimulation is still reliable and can reduce stimulation pain. Considering the importance of the TOF results in determining extubation, the authors suggest the minimal current for the TOF test as 70% SMS.
PURPOSE: The supramaximal stimulation (SMS) of the TOF test causes uncomfortable sensations in patients. We aimed to determine whether the submaximal stimulation would be reliable in TOF tests with reduced painful sensation. METHODS: The accelomyography (AMG) and electromyography (EMG) monitor was applied at each arm and general anesthesia was induced and maintained by total intravenous anesthesia. At extubation, we conducted TOF test three times at each of four different currents: SMS, 70% SMS, 50% SMS, and 30% SMS. The same procedure was performed in the postanesthesia care unit (PACU) only with EMG, and the pain scores on the numerical rating scale (NRS) during the tests were recorded. RESULTS: A total of 36 patients were enrolled. At extubation, TOF ratios with SMS in AMG and EMG were 112.0 ± 13.1% and 93.7 ± 8.9%, respectively. There were no significant differences in TOF ratios between the SMS and lower stimulation intensities. However, 30% and 50% SMS showed significantly higher rates of the unmeasurable results of tests in the PACU. In terms of the stimulation pain, NRS showed a downward pattern as the current decreased and was significantly lower at 50% and 30% SMS than the NRS at SMS. CONCLUSION: The TOF test with submaximal stimulation is still reliable and can reduce stimulation pain. Considering the importance of the TOF results in determining extubation, the authors suggest the minimal current for the TOF test as 70% SMS.
Authors: D M Maybauer; G Geldner; M Blobner; F Pühringer; R Hofmockel; C Rex; H F Wulf; L Eberhart; C Arndt; M Eikermann Journal: Anaesthesia Date: 2007-01 Impact factor: 6.955
Authors: T Fuchs-Buder; C Claudius; L T Skovgaard; L I Eriksson; R K Mirakhur; J Viby-Mogensen Journal: Acta Anaesthesiol Scand Date: 2007-08 Impact factor: 2.105