This Article Résumé de cet Article Full Text Full Text (PDF) Submit a scholarly reply Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Schmidt, J. Articles by Albrecht, S. Search for Related Content PubMed PubMed Citation Articles by Schmidt, J. Articles by Albrecht, S.

A priming technique accelerates onset of neuromuscular blockade at the laryngeal adductor muscles

[Une technique d’amorçage accélère le blocage neuromusculaire au niveau des muscles adducteurs du larynx]

Joachim Schmidt, MD^*, Andrea Irouschek^*, Tino Muenster, MD^*, Thomas M. Hemmerling, MD DEAA and Sven Albrecht, MD^*

^* From the Departments of Anesthesiology, University of Erlangen-Nuremberg, Erlangen, Germany; and
the Centre Hospitalier de l’Université de Montréal, Montreal, Quebec, Canada.

Address correspondence to: Dr. Joachim Schmidt, Department of Anesthesiology, University of Erlangen-Nuremberg, Krankenhausstr. 12, D-91054 Erlangen, Germany. Phone: ±49-9131-8533680; Fax.: ±49-9131-8536147; E-mail: joachim.schmidt{at}gmx.ch

Purpose: Priming is a known technique to accelerate onset of neuromuscular blockade (NMB). Its effect on NMB of the larynx has not been studied yet.

Methods: We compared a priming technique with a bolus application of rocuronium on the onset of NMB at the laryngeal adductor and the adductor pollicis muscles (AP). In 30 female patients, after induction of anesthesia a tube with a surface electrode was placed into the trachea prior to the administration of any neuromuscular blocking agent to monitor electromyography (EMG) of the laryngeal adductor muscles. Neuromuscular monitoring consisted of EMG of the laryngeal adductor muscles and the left AP. Patients were randomized into two groups. After transcutaneous stimulation of the recurrent laryngeal nerve and ulnar nerve, a bolus of rocuronium 0.6 mg·kg^–1 (Bolus group) or a priming dose of rocuronium 0.06 mg·kg^–1 followed by rocuronium 0.54 mg·kg^–1 three minutes later (Priming group) were injected. Lag time, onset 90%, onset time and peak effect of NMB were recorded and compared; a P < 0.05 was considered significant.

Results: The onset 90% and onset time measured at the laryngeal adductor muscles (onset: 44.7 ± 7.4 vs 74.0 ± 23.8 sec) and at the AP (onset: 105.4 ± 29.9 vs 139.2 ± 51.5 sec) were significantly shorter in the Priming group than in the Bolus group. Within groups, the onset times were significantly shorter at the laryngeal muscles in comparison to AP.

Conclusion: Our results indicate that a priming technique with rocuronium significantly accelerates the onset of NMB at the laryngeal adductor muscles. Our results further support the use of rocuronium as an alternative to succinylcholine for rapid sequence induction.

This article has been cited by other articles:

				M. Bock, L. Haselmann, B. W. Bottiger, and J. Motsch Priming with rocuronium accelerates neuromuscular block in children: a prospective randomized study: [L'amorcage avec le rocuronium accelere le bloc neuromusculaire chez les enfants : une etude prospective randomisee] Can J Anesth, July 1, 2007; 54(7): 538 - 543. [Abstract] [Full Text] [PDF]