RELATIONSHIPS OF DIFFERENT PARAMETERS USED FOR THE MEASUREMENT OF NEUROMUSCULAR BLOCKADE

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Monitoring of the action of neuromuscular blocking agents is becoming more important in their rational and safe administration. In order to know the concentrations and the action of these agents and their active metabolites, it is necessary to evaluate various parameters as a whole. In this project, first we developed two types of transducers incorporated in the hand, which are practical and resistant to external disturbances. Tetanic fade and and TOF fade are considered to reflect the presynaptic effect of neuromuscular blocking agents. But it is not certain if these two parameters reflect the same phenomenon. We compared the tetanic contraction of the adductor pollicis muscle and the TOF of EEG of the hypothenar muscle. Tetanic contraction showed presynaptic stimulating effect during the recovery from the neuromuscular blockade, but TOF did not show this phenomenon. EMG of the foot muscle is often used for the measurement of neuromuscular blockade when the monitoring of the adductor pollicis is not possible. We compared the single twitch of the adductor pollicis and the TOF of the EMG of the foot muscle. During the recovery from vecuronium by neostigmine, TOF of the foot was slower to recover compared with the adductor pollicis, but the T1 of the foot exceeded the recovery of adductor pollicis finally. Therefore T1 of the EMG of the foot muscle does not necessary reflect the good recovery of single twitch of the adductor pollicis. In a 19 year old anephric man, we measured both vecuronium and 3-OH vecuronium concentrations and demonstrated that 3-OH vecuronium is contributing to the slow recovery of neuromuscular blockade in this patient. An automatic infusion system of neuromuscular blocking agents based on a closed loop system using a personal computer and monitoring the TOF was developed and this was proved to be clinically useful.