Relaxation

Use of M-NMT in clinical practice

Markku Paloheimo, M.D., Ph.D.
Department of Anesthesia
Eye – ENT Hospital, Helsinki University Hospital
Helsinki, Finland

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This patient required a rapid tracheostomy due to a paralysed vocal cord after brain stem infarction. Patient was induced using fentanyl, propofol, sevoflurane and rocuronium. The patient was intubated without restriction. Subsequently the MechanoSensor was placed on the hand of the patient and monitoring was started using 50 mA stimulation current.

The train-of-four ratio trend depicts a still deepening neuromuscular block. Spontaneous recovery can be seen from the trend and the effect of reversing agents can be confirmed. The increase in oxygen saturation resulted from the administration of 2 manually ventilated breaths.

This patient, a 53-year old male, was anesthetized for a radical neck tumor using propofol, fentanyl, isoflurane in nitrous oxide/oxygen. Vecuronium was used to facilitate endotracheal intubation and as an adjunct to the anesthetic technique. During maintenance, 1 mg doses of vecuronium were given to maintain 1-2 evoked movement responses.

Before the end of the operation, neostigmine and glycopyrrolate were used to reverse the neuromuscular block when it had recovered spontaneously to Count 4, i.e. all four responses were measurable. Note: the plethysmographic pulse amplitude and fingertip temperatures denoting good peripheral circulation and satisfactory monitoring conditions for NMT.

Last updated: 1 June 2000
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