- Joined
- Oct 15, 2005
- Messages
- 655
- Reaction score
- 9
I'm looking at an important graph in Barash, fig 16-14, which shows 7 different muscles and their recovery times after a 0.6 mg/kg dose of rocuronium.
The 7 muscles are divided into a group of 3, 1, and 3. The first group of 3 corresponds to muscles that recover 100% of their twitch height after approximately 25-30 mins. These 3 muscles in order are 1. diaphragm 2. Larynx (laryngeal adductors: vocal cords) 3. Corrugator supercilii (eyebrow).
The next muscle is the 4. abdominal muscles regaining 100% of their twitch height after approximately 35 mins.
The last 3 muscles in order are the 5. orbicularis oculi (eyelid) 6. geniohyoid (upper airway) 7. adductor pollicis (thumb). These muscle regain 100% of their twitch height after apporximately 40 mins.
1. Diaphragm
2. Larynx (laryngeal adductors: vocal cords)
3. Corrugator supercilii (eyebrow)
4. Abdominal muscles
5. Orbicularis oculi (eyelid)
6. Geniohyoid (upper airway)
7. Adductor pollicis (thumb)
The text discusses how monitoring the facial nerve and the eyebrow twitches, which correspond more closely to the vocal cords is a more appropriate monitoring choice for intubation than the thumb. Also, spontaneous respiration is NOT a sign of adequate recovery as the diaphragm is the first muscle to come back. For recovery, monitoring the thumb is optimal since its the last muscle to come back, and corresponds to the geniohyoid and upper airway muscles preventing obstruction upon extubation.
Of note, on the graph, the flexor hallucis (big toe) is not included. It is innervated by the posterior tibial nerve and can be stimulated posterior to the medial malleolus. Barash states that the response of this muscle is comparable to that of the adductor pollicis...hmm...interesting. I guess just think, big toe and thumb are about the same deal.
Comments appreciated.
The 7 muscles are divided into a group of 3, 1, and 3. The first group of 3 corresponds to muscles that recover 100% of their twitch height after approximately 25-30 mins. These 3 muscles in order are 1. diaphragm 2. Larynx (laryngeal adductors: vocal cords) 3. Corrugator supercilii (eyebrow).
The next muscle is the 4. abdominal muscles regaining 100% of their twitch height after approximately 35 mins.
The last 3 muscles in order are the 5. orbicularis oculi (eyelid) 6. geniohyoid (upper airway) 7. adductor pollicis (thumb). These muscle regain 100% of their twitch height after apporximately 40 mins.
1. Diaphragm
2. Larynx (laryngeal adductors: vocal cords)
3. Corrugator supercilii (eyebrow)
4. Abdominal muscles
5. Orbicularis oculi (eyelid)
6. Geniohyoid (upper airway)
7. Adductor pollicis (thumb)
The text discusses how monitoring the facial nerve and the eyebrow twitches, which correspond more closely to the vocal cords is a more appropriate monitoring choice for intubation than the thumb. Also, spontaneous respiration is NOT a sign of adequate recovery as the diaphragm is the first muscle to come back. For recovery, monitoring the thumb is optimal since its the last muscle to come back, and corresponds to the geniohyoid and upper airway muscles preventing obstruction upon extubation.
Of note, on the graph, the flexor hallucis (big toe) is not included. It is innervated by the posterior tibial nerve and can be stimulated posterior to the medial malleolus. Barash states that the response of this muscle is comparable to that of the adductor pollicis...hmm...interesting. I guess just think, big toe and thumb are about the same deal.
Comments appreciated.