ISSN 2398-2950      

Anesthesia: monitoring of neuromuscular blockade

ffelis

Introduction

Uses

  • During neuromuscular blockade administration and recovery:

Advantages

  • Use of peripheral nerve stimulator:
    • Preferred and safer technique.
    • To monitor neuromuscular transmission by electrically stimulating the nerve via percutaneous or transcutaneous electrodes, and measuring either electrical or mechanical responses evoked in the target muscle.
  • Evoked mechanical responses can be gauged in 3 ways:
    • By visually examining the number and strength of 'twitches' - straightforward and feasible but inaccurate.
    • By palpation - inaccurate.
    • By transducing the force of response into a measurable electrical signal - relies on the muscle and limb under test being immobilized in a fixation device - inconvenient, especially in animals where breed differences in limb size and conformation precludes the use of a standard limb-fixation device.

Disadvantages

  • Interpreting nerve stimulation studies may be complicated because responses differ according to species, relaxant used and nerve/muscle unit under examination - under or overestimation of the degree of relaxation at the operation site may result.
  • Agreement between the three methods of quantifying block are not always similar and depend on whether the block is waxing or waning.
  • Most stimulation patterns cause pain in the conscious patient.
  • Improper nerve stimulation can create the impression of a block where none exists.
  • The operation site often limits the ease with which a given nerve may be stimulated.
  • When responses are measured by transduction, the equipment may prove bulky and interfere with surgery.

Requirements

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Preparation

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Procedure

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Outcomes

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Further Reading

Publications

Refereed papers

Other sources of information

  • BSAVA Manual of Small Animal Anaesthesia and Analgesia (1999) Seymour C & Gleed R D (eds)
  • Cullen L K (1996) Muscle relaxants and neuromuscular block. In: Thurmon J C, Tranquilli W J, Benson G J (eds): Lumb & Jones' Veterinary Anesthesia, 3rd edn.  Baltimore: Williams & Wilkins, pp 337-364.

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