Pulmonary function and head lift during spontaneous recovery from pipecuronium neuromuscular block

• Published in: British journal of anaesthesia : BJA 1995-01, Vol.74 (1), p.16-19
• Main Authors: EL MIKATTI, N., WILSON, A., POLLARD, B.J., HEALY, T.E.J.
• Format: Article
• Language: English
• Subjects: Adult; Anesthesia Recovery Period; Anesthetics. Neuromuscular blocking agents; Biological and medical sciences; Diplopia - chemically induced; Electric Stimulation; electro-myography; Electromyography; Female; Forced Expiratory Volume - drug effects; function; Humans; Lung; Lung - physiology; Male; measurement of response; Measurement techniques; Medical sciences; Middle Aged; Neck Muscles - drug effects; Nerve Block; Neuromuscular block; Neuromuscular Junction - drug effects; Neuropharmacology; Peak Expiratory Flow Rate - drug effects; Pharmacology. Drug treatments; pipecuronium; Pipecuronium - adverse effects; Pipecuronium - pharmacology; Respiratory Function Tests; Respiratory Muscles - drug effects; Vital Capacity - drug effects
• ISSN: 0007-0912; 1471-6771
• DOI: 10.1093/bja/74.1.16

We have studied in seven healthy conscious volunteers the correlation between the electro-myographic (EMG) and clinical criteria used to identify adequate recovery from sub-paralysing doses of pipecuronium. Pipecuronium (mean dose 1.88 (range 0.92–3.16) mg) was administered to reach a T4/T1 ratio of 0.5; full recovery to 1.0 was produced in a mean time of 25.3 (14–39) min. During recovery from neuromuscular block, we measured tidal volume, forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1) negative inspiratory pressure (NIP), peak expiratory flow rate (PEFR), mid-expiratory flow rate (MEFR) and 5-s head lift. The assessments were started when the train-of-four (TOF) ratio reached 0.5 ± 0.001 and repeated at each 0.1 ± 0.001 increase up to a ratio of 1.0. All volunteers showed ptosis and diplopia after the first dose and difficulty in swallowing with subsequent doses. They also experienced a pleasant, relaxing sedative sensation. All could sustain head lift for 5 s at a TOF ratio of 0.5 and higher, except for one subject who could not lift his head only at a ratio of 0.5. There was a statistically significant decrease in FVC, FEV, and PEFR with a nonsignificant decrease in other pulmonary measurements, except for NIP which only decreased significantly at a ratio of 0.5. These changes are probably of no clinical importance. All the measured respiratory variables returned to control values at a TOF ratio of 0.9. (Br.J. Anaesth. 1995; 74: 16–19)