| The Isolation Arm Test for the Assessment of Neuromuscular Biockade ; Reevaluation of Injection Site Influencing to the Twitch Responses. |
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Sung Yell Kim, Kyung Ho Hwang, Sun Chong Kim, Wook Park, Kee Ryang Ahn, Chun Sook Kim |
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Department of Anesthesiology, School of Medicine, Soon Chun Hyang University, Seoul, Korea. |
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| Abstract |
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The isolation arm test at upper limb for the study of muscle relaxants sensitivity of human muscle is described. In the healthy adults, succinylcholine 100ug/kg or vecuronium 5~6ug/kg combined with 20ml saline is given intravenously at various sites of injection while the circulation to the arm is occluded with upper arm pneumatic tournique. After injection of muscle relaxants, neuromuscular transmission is then studied by TOF stimulation to ulnar nerve with EMG monitor(ABM, Dates) and changes of twitch response in evoked muscle action potential amplitude from hypothenar muscle are recorded. In the results, twitch height is depressed weakly and slowly but incompletely after muscle relaxant is injected intravenously at cubital fossa, and declines further depression following recovery after the release of upper arm tourniquet occiuded systemic circulation(two stage response). There are not any changes of twitch response while muscle relaxants are given intravenously between upper arm and forearm pneumatic tourniquet. But twitch height is depressed rapidely and completely after muscle relaxants are given intravenously at doris hand under the upper arm or forearm pneumatic tourniquet. Conclusively, twitch response under the isolation arm test is influenced from the site of injection, and in order to obtain the correct assessment of neuromuscular blockade, muscle relaxants will be given intravenously at dorsi hand with forearm pneumatic tourniquet. |
| Key Words:
Neuromuscular blockade; Succinylcholine; Vecuronium; Regional technique; Isolation arm test |
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