The effect of prior tetanic stimulation on train-of-four monitoring in paediatric patients: A randomised open-label controlled trial


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Abstract

BACKGROUNDIn clinical research, neuromuscular monitoring must present a stable response for a period of 2 to 5 min before administration of a neuromuscular blocking agent. The time required to reach this stable response may be shortened by applying a 5-s tetanic stimulus.OBJECTIVESThe aim of this study was to test whether tetanic stimulation interferes with onset and recovery times after a single dose of rocuronium 0.6 mg kg−1 followed by spontaneous recovery.DESIGNA randomised, open-label, controlled trial.SETTINGA single-centre trial, study period from January 2014 to July 2015.PATIENTSFifty children aged 2 to 11 years scheduled for elective paediatric surgery.INTERVENTIONPatients were randomly allocated to receive either tetanic stimulation (group T) or not (group C) before calibration of the neuromuscular monitor.MAIN OUTCOME MEASURESOnset and recovery times. Initial and final T1 height, time to obtain initial T1 height stability and monitor settings were also analysed.RESULTSThere was no significant difference in mean onset time [(C: 57.5 (± 16.9) vs. T: 58.3 (± 31.2) s; P = 0.917]. Mean times to normalised train-of-four (TOF) ratios of 0.7, 0.8 and 0.9 were significantly shorter in the tetanic stimulation group [C: 40.1 (±7.9) vs. T: 34.8 (±10) min; P = 0.047, C: 43.8 (±9.4) vs. T: 37.4 (±11) min; P = 0.045 and C: 49.9 (±12.2) vs. T: 41.7 (±13.1) min; P = 0.026, respectively]. The mean time required for T1 height stabilisation was similar in the two groups [C: 195.0 (± 203.0) vs. T: 116.0 (± 81.6) s; P = 0.093], but the initial and final T1 height values were significantly lower in the tetanic stimulation group (C: 98.0 vs. T: 82.7%; P < 0.001 and C: 95.3 vs. T: 69.3%; P < 0.001, respectively).CONCLUSIONTetanic stimulation shortened the mean times to normalised TOF ratios of 0.7, 0.8 and 0.9, but there was no difference in the mean onset time or the mean time required for T1 height stabilisation after a single dose of rocuronium 0.6 mg kg−1 followed by spontaneous recovery in children aged 2 to 11 years.TRIAL REGISTRATIONClinicaltrials.gov. identifier: NCT02498678.

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