A neuromuscular function monitoring

After neuromuscular relaxation, a muscle contraction decreases depending on the number of fibbers blocked. A peripheral nerve stimulation and observing contraction of the fingers is the most commonly advocated method of neuromuscular blockade monitoring. It become simple and easy to perform after portable peripheral nerve stimulators were introduced into the routine clinical work. Three types of peripheral nerve stimulation are most used: a single twitch, train-of four (TOF), and sustained tetanic stimulation. A posttetanic count and double-burst stimulation were recently introduced. The TOF monitoring is common method for the neuromuscular blockade assessment due to its advantages. A TOF-Watch apparatus (Organon) was used for neuromuscular function monitoring in operating theatres and ICU of The Clinic for Tumours. TOF responses are assessed after ulnar nerve stimulation before relaxation, when intubating conditions are achieved, 15 minutes later and every five minutes thereafter. An increments of relaxant are supplemented when a first twitch appear in abdominal surgery and after second twitch in the ENT and breast surgery. A residual neuromuscular blockade was antagonized by neostigmin at the end of surgery. Neuromuscular function monitoring with peripheral nerve stimulation was proven as clinically useful method. Due to great interindividual metabolic variations, this method can be used to detect both need for additional doses of muscle relaxants and antagonists in the course of the surgery. It is important for residual neuromuscular blockade assessment in mechanically ventilated patients the ICU. Despite subjective clinical signs, which were influenced by number of conditions and diseases, quantitative conclusions may be guarded by TOF-Watch nerve stimulator.