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KMID : 0356919930260020272
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Korean Journal of Anesthesiology
1993 Volume.26 No. 2 p.272 ~ p.277
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Assessment of Facial Nerve Stimulation Methods to Determine the Optimal Time for Tracheal Intubation after Vecuronium Injection
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김교상
한정욱/전종헌/심재철/김경헌/이동호/성정국/유희구/승익상
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Abstract
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Absence of response to train of four(TOF) and single twitch stimulation at ulnar nerve did not guarantee ideal intubation conditions after vecuronium. The double stimulation(DBS) introduced by Viby-Mogensen, made it easier to evaluate
postoperative
residual neuromuscular blockade manually than did the use of the TOF method.
The purpose of this study was to examine which will be the best stimulus among DBS,TOFand single twitch stimulation(STS) for an indicator of the optimal time for tracheal intubation.
One hundred and nine healthy patients were randomly allocated to three groups in which DBS(n=34), TOF(n=38) and STS(n=37) group. Anesthesia was induced with thiopental sodium 3~5 mg/kg and maintained 1% enflurane until intubation.
Neuromuscular block was induced by intravenous vecuronium0.1 mg/kg , and applied facial nerve stimuli immediately by DBS, TOF and STS using INNERVATOR(Fisher and Paykei Co.) continuously. The complete relaxation relaxation time of orbicularis
oculi
muscle was closely observed with author's naked eyes.
Tracheal intubation was performed immediately by the author after disappearance of the response to stimuli. The intubation time from intravenous injection of vecuronium was recorded, and the intubating conditions were evaluated by vocal cords
opening,
coughing reflex and response to laryngoscopy attempts.
The intubation time was 195.9(74.7(90~390) seconds in DBS group, 180.9(49.8(100~290) seconds in ToF group and 167.7(37.9(90~270) seconds in STS group and there were no statistically significant difference.
There were also no significance on vocal cords opening and response to laryngoscopy attempts in three groups but DBS group was statistically less cough reflex than TOF group and STS group(P<0.05).
With the above results the authors concluded that DBS on the facial nerve with the orvicularis oculi muscle was most reliable index to determine the optimal time for tracheal intubation and thetime was about 196 seconds after vecuronium.
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