Key result
Double burst stimulation was more sensitive than train of four monitoring in detecting residual neuromuscular blockade, with 85.4% of patients safely extubated when DBS showed no fade compared to 14.5% when TOF showed no fade.
Why the study?
Fade in train of four (TOF) response cannot be identified visually or manually once recovered past 0.4 to 0.5, prompting evaluation of whether double burst stimulation is more sensitive in assessing residual neuromuscular blockade.
Does double burst stimulation (DBS) improve the detection of residual neuromuscular blockade compared to train of four (TOF) monitoring in patients undergoing elective surgery?
Observational (n=55)
No
Does double burst stimulation (DBS) improve the detection of residual neuromuscular blockade compared to train of four (TOF) monitoring in patients undergoing elective surgery?
Absolute Event Rate: 85.4% vs 14.5%
Double burst stimulation is more sensitive and reliable than train of four monitoring in detecting residual neuromuscular blockade prior to extubation.
DBS may improve residual blockade detection before extubation; leaves open confirmation of clinical benefit in randomized trials.
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.
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Dhivya et al. (2023) conducted an observational in Patients undergoing elective surgery under general anesthesia (n=55). Double burst stimulation (DBS) vs. Train of four (TOF) monitoring was evaluated on Patients extubated based on absence of fade. Double burst stimulation was more sensitive than train of four monitoring in detecting residual neuromuscular blockade, with 85.4% of patients safely extubated when DBS showed no fade compared to 14.5% when TOF showed no fade.
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