A comparison of train of four monitoring and double burst stimulation to assess residual neuromuscular blockade

Abstract

Background and Aim: After introduction of train of four (TOF) monitoring residual neuromuscular blockade was reduced but without quantitative recording of evoked response it is difficult to estimate the TOF ratio. Thus, when TOF ratio is recovered to more than 0.4 -0.5 fade in response cannot be identified visually or manually. To overcome this double burst stimulation (DBS) was introduced. The aim of this study is to assess whether DBS is more sensitive than TOF in assessing neuromuscular blockade.Methods: 55 patients, aged 18 to 60 years undergoing elective surgery under general anaesthesia using endotracheal intubation where randomised selected. Neuromuscular transmission was not monitored until following reversal of neuromuscular blockade. Following neostigmine administration, TOF stimulation was given with 50mA every 30 seconds. DBS was given only when there was absence of fade of TOF. if fade is present in DBS stimulation was given every 30 seconds till there was no fade.Results: In our study the duration from TOF equal to DBS equal varied from 2.6 minutes to 6.7 minutes with mean of 4.6minutes. More number of patients where extubated on DBS equal group.Conclusion: DBS is more helpful than TOF in detecting residual neuromuscular blockade.