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d'Honneur G.; Slavov V.; Merle J. C.; Kirov K.; Rimaniol J. M.; Sperry L.; Duvaldestin P. 《British journal of anaesthesia》1996,77(6):716-719
Although subjects often report difficulty with swallowing shortly after
receiving neuromuscular blocking agents, difficulty with swallowing during
recovery from neuromuscular blocking agents appears to be infrequent. We
have used electromyography to compare onset and recovery at the diaphragm
and geniohyoid airway muscles after an intubating dose of mivacurium (0.2
mg kg-1) to determine if the geniohyoid muscles were particularly sensitive
to neuromuscular blocking agents. Twelve adults undergoing elective surgery
were anaesthetized with propofol and fentanyl and the trachea intubated
without neuromuscular blocking agents. The left hypoglossal and right
phrenic nerves were stimulated with percutaneous needle electrodes and the
electromyogram recorded with surface electrodes. EMG responses were
measured after a bolus dose of mivacurium 0.2 mg kg-1. Recordings were also
made of the mechanical response of the adductor pollicis to supramaximal
ulnar nerve stimulation. There was no difference in the rate of onset of
block for geniohyoid muscles and the diaphragm, but recovery to 25% and 90%
of the control response was shorter at the diaphragm (median 14.5 (95%
confidence limits 12.9-15.3) min and 23.8 (21.7-26) min) than at the
geniohyoid muscle (19.4 (15.6-20.1) min and 29.2 (26.3-31.4) min),
respectively (P < 0.05). When the train-of-four ratio of the mechanical
response of the thumb reached 70%, the diaphragm and geniohyoid muscles had
recovered completely in all patients.
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