Rocuronium Vs. Cisatracurium: Comparision Of The TOF Count By Visual Assessment And The Actual First Twitch Response By Accelomyography

Aim: To investigate the feasibility of assessing the actual first twitch response of trainof four (TOF) by subjective qualitative evaluation (TOF count).Methods: One hundred and eight patients, scheduled for elective surgical procedurewere enrolled. Target-controlled infusion (TCI) of propofol and Constant-speedinfusion of remifentanil to maintain anesthesia. The response to ulnar nervestimulation was recorded by the TOF WATCH SX Monitor. Intraoperatively, withneuromuscular monitor which evoked the twitch response of adductor pollicis, therecovery process of double ED95rocuronium and cisatracurium were recorded byapplication of visual assessment. According to the given different muscle relaxation,patients were randomly assigned to four subgroups. For the men rocuronium group(Rm group,27cases), female rocuronium group (Rf group,27cases); malecisatracurium group (Cm group,27cases) and the female cisatraurium group (Cfgroup,27cases). The following pharmacodynamic parameters were measured in allpatients: The four T1values corresponding to the four sequential TOF-inducedresponses. T0-T1(min)=time interval from Tmaxto spontaneous recovery of actual T1reappearance. T1-T2(min)=time interval from actual T1to actual T2reappearance.T1-T3(min)=time interval from actual T1to actual T3reappearance. T1-T4(min)=time interval from actual T1to actual T4reappearance. TOFr when the T4 reappearance. When the TOF count by application of visual assessment is equal to1,2,3and4, the actual T1values from neuromuscular monitor was recorded as C1, C2,C3, and C4. T0-C1(min)=time interval from Tmaxto spontaneous recovery of TOFcount1reappearance by visual assessment. C1-C2(min)=time interval from thespontaneous recovery of TOF count1reappearance to TOF count2by visualassessment. C1-C3(min)=time interval from the spontaneous recovery of TOF count1reappearance to TOF count3by visual assessment. C1-C4(min)=time intervalfrom the spontaneous recovery of TOF count1reappearance to TOF count4by visualassessment.Results: Four groups were compared T0-C1, T0-T1. Cm group is longer than Rmgroup (P <0.05), Cf group is longer than Rf group (P<0.05), while in grouprocuronium and cisatracurium, gender differences are not significant (P>0.05).Among the four groups, no significant difference showed in C1-C2, C1-C3, C1-C4,T1-T2, T1-T3and T1-T4, respectively (P>0.05). In all the four groups, there is notany significant difference between C1-C2and T1-T2, C1-C3and T1-T3, and C1-C4and T1-T4(P>0.05). In the four groups of patients (n=108), the four T1valuescorresponding to the four sequential TOF-induced responses are4.0(3.0,4.0)%,12.0(10.0,16.0)%,22.0(18.0，27.0)%,27.0(21.3，33.0)%, respectively. When TOF count=1, the actually measured T1value in all four groups of patients (n=108) is zero.When TOF count=2,3and4, the corresponding T value is0.0(0.0,3.8)%,6.0(5.0,9.0)%and9.0(6.0,13.0)%, respectively.Conclusion: Rocuronium is rapid than cisatracurium in the time from deep block tothe early stage of recovery. The T1observed by visual assessment emerges obviouslyearlier than that recorded by accelomyography TOF WATCH SX. The TOF count1emergence time helps to predict the time of TOF count1,2,3and4emergence whichsuggest a certain degree of neuromuscular blockade recovery.