Assessment of neuromuscular block at the thumb and great toe using accelography in infants

Abstract

We assessed neuromuscular block at the thumb and great toe using accelography after the administration of vecuronium in infants. Train-of-four stimuli were simultaneously applied to the ulnar and tibial nerves using cutaneous electrodes. Anaesthesia was maintained with nitrous oxide (66%) in oxygen and sevoflurane (1%). Vecuronium 0.1 mg.kg-1 was used for paralysis and reversed with intravenous neostigmine 0.04 mg.kg-1 when the train-of-four ratio on the right great toe returned to 25%. The mean (SD) times from administration of vecuronium to completion of maximal block on the thumb and great toe were 78 (21.1)s and 75 (14.3)s, respectively (p >0.05). The times from block to 25% recovery of twitch height at the thumb and great toe were 46 (9.1)min, respectively. The reversal time from 25% to 75% of the train-of-four ratio after administration of neostigmine was 136 (49.1)s. We conclude that neuromuscular monitoring of the great toe in infants may be a suitable alternative when the thumb is inaccessible.