Skip to main content
Erschienen in: Journal of Clinical Monitoring and Computing 6/2020

30.11.2019 | Original Research

Shortening of the twitch stabilization period by tetanic stimulation in acceleromyography in infants, children and young adults (STSTS-Study): a prospective randomised, controlled trial

verfasst von: Christoph Unterbuchner, Markus Werkmann, Raphael Ziegleder, Stephanie Kraus, Timo Seyfried, Bernhard Graf, Florian Zeman, Manfred Blobner, Barbara Sinner, Thomas Metterlein

Erschienen in: Journal of Clinical Monitoring and Computing | Ausgabe 6/2020

Einloggen, um Zugang zu erhalten

Abstract

Acceleromyography is characterised by an increase of the twitch response T1 (first twitch of the train-of-four [TOF]) during first 30 min of monitoring known as the staircase phenomenon. In adults the staircase phenomenon can be avoided by tetanic prestimulation. This study examined, if tetanic prestimulation eliminates the staircase phenomenon in children. After written informed consent, the neuromuscular function of 80 children, 10 in each age group (< 6 months, 6–12 months, 12–24 months, 2–3 years, 3–6 years, 6–12 years, 12–18 years, and ≥ 18 years) was measured on both arms simultaneously over 30 min under general anaesthesia. The ulnaris nerve was stimulated using the TOF technique every 15 s. The twitch response (T1, TOF ratio [TOFR]) was measured by acceleromyography. Before calibration, tetanic prestimmulation (50 Hz for 5 s) was administered to one randomly selected arm. The effect of tetanic prestimulation and age was analysed using general linear models based on the normalized T1 and TOFRs of both arms. Tetanic prestimulation significantly affected T1 values avoiding the staircase phenomenon (p < 0.0001). After 5.8 min [1.0–17.2 min] the normalized T1 values increased to 117% [102–147%] without prestimulation (p < 0.0001) independent of the age group (p = 0.539). The normalized TOFR was stable throughout the observation period of 30 min 100% [95–107%]. Infants (> 12 weeks), children, and young adults (< 18 years) develop similar characteristics of the staircase phenomenon than adults. Tetanic prestimulation prevents the staircase phenomenon in these age groups. The stability of the TOFR reading confirms its value to monitor neuromuscular function over time.
Registration: The study was registered as NCT02552875 on Clinical Trials.gov on July 29, 2014.
Literatur
4.
Zurück zum Zitat Krarup C. Enhancement and diminution of mechanical tension evoked by staircase and by tetanus in rat muscle. J Physiol. 1981;311:355–72.CrossRef Krarup C. Enhancement and diminution of mechanical tension evoked by staircase and by tetanus in rat muscle. J Physiol. 1981;311:355–72.CrossRef
5.
Zurück zum Zitat Ritchie JM, Wilkie DR. The effect of previous stimulation on the active state of muscle. J Physiol. 1955;130(2):488–96.CrossRef Ritchie JM, Wilkie DR. The effect of previous stimulation on the active state of muscle. J Physiol. 1955;130(2):488–96.CrossRef
7.
Zurück zum Zitat Lee GC, Iyengar S, Szenohradszky J, Caldwell JE, Wright PM, Brown R, Lau M, Luks A, Fisher DM. Improving the design of muscle relaxant studies. Stabilization period and tetanic recruitment. Anesthesiology. 1997;86(1):48–54.CrossRef Lee GC, Iyengar S, Szenohradszky J, Caldwell JE, Wright PM, Brown R, Lau M, Luks A, Fisher DM. Improving the design of muscle relaxant studies. Stabilization period and tetanic recruitment. Anesthesiology. 1997;86(1):48–54.CrossRef
8.
Zurück zum Zitat Driessen JJ, Robertson EN, Booij LH. Acceleromyography in neonates and small infants: baseline calibration and recovery of the responses after neuromuscular blockade with rocuronium. Eur J Anaesthesiol. 2005;22(1):11–5.CrossRef Driessen JJ, Robertson EN, Booij LH. Acceleromyography in neonates and small infants: baseline calibration and recovery of the responses after neuromuscular blockade with rocuronium. Eur J Anaesthesiol. 2005;22(1):11–5.CrossRef
10.
Zurück zum Zitat Kopman AF, Kumar S, Klewicka MM, Neuman GG. The staircase phenomenon: implications for monitoring of neuromuscular transmission. Anesthesiology. 2001;95(2):403–7.CrossRef Kopman AF, Kumar S, Klewicka MM, Neuman GG. The staircase phenomenon: implications for monitoring of neuromuscular transmission. Anesthesiology. 2001;95(2):403–7.CrossRef
13.
Zurück zum Zitat McCoy EP, Mirakhur RK, Connolly FM, Loan PB. The influence of the duration of control stimulation on the onset and recovery of neuromuscular block. Anesth Analg. 1995;80(2):364–7.PubMed McCoy EP, Mirakhur RK, Connolly FM, Loan PB. The influence of the duration of control stimulation on the onset and recovery of neuromuscular block. Anesth Analg. 1995;80(2):364–7.PubMed
14.
Zurück zum Zitat Rassier DE, Macintosh BR. Coexistence of potentiation and fatigue in skeletal muscle. Braz J Med Biol Res. 2000;33(5):499–508.CrossRef Rassier DE, Macintosh BR. Coexistence of potentiation and fatigue in skeletal muscle. Braz J Med Biol Res. 2000;33(5):499–508.CrossRef
15.
Zurück zum Zitat Rassier DE, Tubman LA, MacIntosh BR. Staircase in mammalian muscle without light chain phosphorylation. Braz J Med Biol Res. 1999;32(1):121–9.CrossRef Rassier DE, Tubman LA, MacIntosh BR. Staircase in mammalian muscle without light chain phosphorylation. Braz J Med Biol Res. 1999;32(1):121–9.CrossRef
16.
Zurück zum Zitat Curless RG. Developmental patterns of peripheral nerve, myoneural junction and muscle: a review. Prog Neurobiol. 1977;9(4):197–209.CrossRef Curless RG. Developmental patterns of peripheral nerve, myoneural junction and muscle: a review. Prog Neurobiol. 1977;9(4):197–209.CrossRef
17.
Zurück zum Zitat Round JM, Jones DA, Chapman SJ, Edwards RH, Ward PS, Fodden DL. The anatomy and fibre type composition of the human adductor pollicis in relation to its contractile properties. J Neurol Sci. 1984;66(2–3):263–72.CrossRef Round JM, Jones DA, Chapman SJ, Edwards RH, Ward PS, Fodden DL. The anatomy and fibre type composition of the human adductor pollicis in relation to its contractile properties. J Neurol Sci. 1984;66(2–3):263–72.CrossRef
18.
Zurück zum Zitat Krarup C. Electrical and mechanical responses in the platysma and in the adductor pollicis muscle: in normal subjects. J Neurol Neurosurg Psychiatry. 1977;40(3):234–40.CrossRef Krarup C. Electrical and mechanical responses in the platysma and in the adductor pollicis muscle: in normal subjects. J Neurol Neurosurg Psychiatry. 1977;40(3):234–40.CrossRef
19.
Zurück zum Zitat Diaz-Cambronero O, Flor Lorente B, Mazzinari G, Vila Montanes M, Garcia Gregorio N, Robles Hernandez D, Olmedilla Arnal LE, Argente Navarro MP, Schultz MJ, Errando CL, group IPs. A multifaceted individualized pneumoperitoneum strategy for laparoscopic colorectal surgery: a multicenter observational feasibility study. Surg Endosc. 2019;33(1):252–60. https://doi.org/10.1007/s00464-018-6305-y.CrossRefPubMed Diaz-Cambronero O, Flor Lorente B, Mazzinari G, Vila Montanes M, Garcia Gregorio N, Robles Hernandez D, Olmedilla Arnal LE, Argente Navarro MP, Schultz MJ, Errando CL, group IPs. A multifaceted individualized pneumoperitoneum strategy for laparoscopic colorectal surgery: a multicenter observational feasibility study. Surg Endosc. 2019;33(1):252–60. https://​doi.​org/​10.​1007/​s00464-018-6305-y.CrossRefPubMed
20.
Zurück zum Zitat Ali HH, Utting JE, Gray C. Stimulus frequency in the detection of neuromuscular block in humans. Br J Anaesth. 1970;42(11):967–78.CrossRef Ali HH, Utting JE, Gray C. Stimulus frequency in the detection of neuromuscular block in humans. Br J Anaesth. 1970;42(11):967–78.CrossRef
24.
Zurück zum Zitat Miller RD, Eger EI 2nd, Way WL, Stevens WC, Dolan WM. Comparative neuromuscular effects of Forane and halothane alone and in combination with d-tubocurarine in man. Anesthesiology. 1971;35(1):38–42.CrossRef Miller RD, Eger EI 2nd, Way WL, Stevens WC, Dolan WM. Comparative neuromuscular effects of Forane and halothane alone and in combination with d-tubocurarine in man. Anesthesiology. 1971;35(1):38–42.CrossRef
25.
Zurück zum Zitat Goudsouzian NG. Maturation of neuromuscular transmission in the infant. Br J Anaesth. 1980;52(2):205–14.CrossRef Goudsouzian NG. Maturation of neuromuscular transmission in the infant. Br J Anaesth. 1980;52(2):205–14.CrossRef
Metadaten
Titel
Shortening of the twitch stabilization period by tetanic stimulation in acceleromyography in infants, children and young adults (STSTS-Study): a prospective randomised, controlled trial
verfasst von
Christoph Unterbuchner
Markus Werkmann
Raphael Ziegleder
Stephanie Kraus
Timo Seyfried
Bernhard Graf
Florian Zeman
Manfred Blobner
Barbara Sinner
Thomas Metterlein
Publikationsdatum
30.11.2019
Verlag
Springer Netherlands
Erschienen in
Journal of Clinical Monitoring and Computing / Ausgabe 6/2020
Print ISSN: 1387-1307
Elektronische ISSN: 1573-2614
DOI
https://doi.org/10.1007/s10877-019-00435-4

Weitere Artikel der Ausgabe 6/2020

Journal of Clinical Monitoring and Computing 6/2020 Zur Ausgabe

Update AINS

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.