Twitch potentiation: a potential source of error during neuromuscular monitoring with acceleromyography in anesthetized dogs.

Research paper by Manuel M Martin-Flores, Eileen J EJ Lau, Luis L Campoy, Hollis N HN Erb, Robin D RD Gleed

Indexed on: 02 Jun '11Published on: 02 Jun '11Published in: Veterinary Anaesthesia and Analgesia


To measure twitch potentiation (the staircase phenomenon) in anesthetized dogs, and assess its relevance during neuromuscular monitoring with acceleromyography (AMG).Randomized, prospective clinical trial.Sixteen dogs undergoing ovariohysterectomy.Under isoflurane anesthesia, neuromuscular function was monitored with train-of-four (TOF) stimuli every 15 seconds and quantified by AMG. Neuromuscular blockade (NMB) was produced with 0.15 mg kg(-1) atracurium IV. Dogs were randomly divided into two groups; a potentiation group (PG) in which TOF stimulation was applied for 20 minutes before atracurium was administered; and a control group (CG) where no such time was allowed. In both groups, the AMG was calibrated (at tCAL) just before atracurium was administered. TOF stimulation continued throughout the experiment in all dogs. The height of the first twitch (T(1)) (expressed as a fraction of T(1) at tCAL) and train-of-four ratio (TOFR) were recorded until TOFR returned to ≥90%.In PG, T(1) increased significantly (p = 0.0078) from a median of 102% (range, 95, 109) at baseline to 118% (100, 142) at 20 minutes. In PG, no difference was found between T(1) at tCAL (immediately before atracurium administration) and T(1) when neuromuscular transmission returned (p = 0.42). In the CG, T(1) increased significantly between tCAL and the time neuromuscular transmission returned (p = 0.027). TOFR did not increase during twitch potentiation (all p = 0.32).T(1) increased significantly during 20 minutes of uninterrupted TOF stimulation in the absence of NMB, establishing that twitch potentiation occurs in anesthetized dogs. With no time for potentiation, T(1) increased during the course of recovery from NMB; this phenomenon introduces a bias in T(1) measurements and could affect studies reporting potency and duration of NMB based on T(1) or single twitches. TOFR was unaltered by potentiation emphasizing its clinical usefulness for excluding post-operative residual NMB.