Recovery of Neuromuscular Block After Tourniquet Inflation: Comparison of Atracurium and Vecuronium

Authors: S. YILDIRIM, A. C. ŞENEL, G. AKTÜRK, İ. ÖZEN

Abstract: To determine the influence of circulatory factors on recovery from neuromuscular block, we measured train of four (TOF) response in the arm with tourniquet inflated during TOF = 0.1 and compared this with data from a control arm in 40 patients under fentanyl-propofol-nitrous oxide-isoflurane anaesthesia. Patients were allocated randomly to receive either atracurium 0.5 mg/kg (n=20) or vecuronium 0.1 mg/kg (n=20). The TOF response of ulnar nerve in both arms was recorded in every 12 sec. When neuromuscular block was 90% (TOF = 0.1), the tourniquet was inflated to a pressure of 300 mmHg, and when a neuromuscular block recovery of 75% was reached, the block recovery time in both perfused and tourniquet arms was determined. The recorvery from neuromuscular block was markedly delayed in the tourniquet arms in both groups (p<0.01). As the recorvery time was longer in the vecuronium group than in atracurium group, we suggest the use of vecuronium in the microsurgery of the isolated extremities.

Keywords: Neuromuscular block, atracurium, vecuronium, measurement of response.

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