Response to single twitch or single burst stimulation of the ulnar nerve as predictive guide for intubating conditions

Abstract

Disappearance of response to single twitch stimulation (STS) or train-of-four stimulation (TOF) of the ulnar nerve is insufficient as predictive guide for intubating conditions during onset of non-depolarizing neuromuscular block. Double burst stimulation (DBS) appears to be a more reliable indicator of the optimal time for intubation. In the present study, the disappearance of tactile detectable response to 0.1 Hz single twitch stimulation (STS) of the ulnar nerve was compared with disappearance of response to 0.1 Hz single burst stimulation (three stimuli at 50 Hz = SBS) as predictor for optimal intubating conditions during onset of block induced by 0.08 mg.kg-1 of vecuronium in 100 patients under light general anaesthesia where thiopentone was used as the sole anaesthetic. Intubation was performed immediately after disappearance of the twitch response. Likewise 0.05 Hz STS and 0.05 Hz SBS stimulation were compared under identical circumstances in another 100 patients. Intubating conditions were unacceptable in 10%, 14%, 8% and 10% of the patients in the 0.1 Hz STS, 0.1 Hz SBS, 0.05 Hz STS and 0.05 Hz SBS groups, respectively. There were no significant differences between the groups. In conclusion, neither absence of response to STS stimulation nor absence of response to SBS stimulation of the ulnar nerve at either 0.1 Hz or 0.05 Hz frequency does guarantee acceptable intubating conditions during onset of neuromuscular block induced by vecuronium 0.08 mg.kg-1 when thiopentone is used as the sole anaesthetic.