Key result
Tetanic stimulation prior to train-of-four monitoring did not significantly reduce the time to T1 height stabilisation compared to control in patients aged 60 to 80 years (4.3 vs 5.8 minutes, p=0.42).
Why the study?
The study was conducted to determine the effect of tetanic stimulation in patients aged 60 to 80 years on the time required to achieve stabilisation of the T1 height.
Does tetanic stimulation prior to train-of-four monitoring reduce the time to muscle response stabilisation in patients aged 60 to 80 years undergoing general anaesthesia?
RCT (n=50)
Single-blind
1:1 ratio
Yes
Does tetanic stimulation prior to train-of-four monitoring reduce the time to muscle response stabilisation in patients aged 60 to 80 years undergoing general anaesthesia?
Tetanic stimulation prior to train-of-four monitoring does not significantly reduce the time to muscle response stabilization in older adults (60-80 years) undergoing general anesthesia.
Tetanic stimulation confers no benefit for T1 stabilization or rocuronium pharmacodynamics in patients aged 60–80; challenges extrapolation of adult neuromuscular monitoring recommendations to this group.
Purpose To determine the effect of tetanic stimulation in patients aged 60 to 80 years on the time to achieve stabilisation of the T1 height. Methods This multicentre, randomised, open-label and controlled trial was conducted in two tertiary public hospitals in Brazil from December 2019 to February 2022. Seventy patients aged 60 to 80 years undergoing elective surgery under general anaesthesia were randomly allocated to receive tetanic stimulation to achieve T1 height stabilisation on train-of-four monitoring or not. We evaluated the effect of tetanic stimulation in patients aged 60–80 years on the time to achieve stabilisation of the T1 height, time to the onset of action of the neuromuscular blocking agent, and neuromuscular block recovery times after a single dose of rocuronium 0.6 mg.kg− 1. Results There was no statistically significant difference between the two groups in the time to T1 height stabilisation (control: 5.8 [2.0-10.5] min; tetanic: 4.3 [2.0–8.0] min; p = 0.42), onset time of the neuromuscular blocking agent (control: 2.2 [± 1.0] min; tetanic: 1.9 [± 0.7] min; p = 0.295), or neuromuscular block recovery times to normalised TOF values of 0.7 (control: 91.7 [± 27.5] min; tetanic: 106.1 [± 37.2] min; p = 0.126), 0.8 (control: 97.8 [± 28.9] min; tetanic: 114.3 [± 40.1] min; p = 0.101), 0.9 (control: 106.9 [± 30.6] min; tetanic: 126.5 [± 44.0] min; p = 0.074), or 1.0 (control: 123 [± 43.5] min; tetanic: 134.1 [± 44.5] min; p = 0.425). Conclusion The recommendation to use tetanic stimulation to shorten the time to T1 height stabilisation in neuromuscular monitoring does not apply to patients older than 60 years. Trial registration : The study was registered on the Brazilian Clinical Trials Registry (ReBEC) platform (number RBR-35msdt).
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Ribeiro et al. (2023) conducted an RCT in Patients undergoing elective surgery under general anaesthesia (n=50). Tetanic stimulation vs. No tetanic stimulation was evaluated on Time to achieve T1 height stabilisation (p=0.42). Tetanic stimulation prior to train-of-four monitoring did not significantly reduce the time to T1 height stabilisation compared to control in patients aged 60 to 80 years (4.3 vs 5.8 minutes, p=0.42).
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