patient twitching during surgery

[lakersbaby]

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Doing a breast case and surgeon says the patient is "very twitchy" as she cauterizes. I have 0/4 twitches on my nerve stimulator. Doesn't cautery itself stimulate muscle fibers to twitch regardless of paralysis or will full NM blockade prevent twitch even with direct electric stimulation? I end up giving 2 more of vecuronium and hear no more from the surgeon.

 

[Colbare]

I'm interested to know I wonder if the cautery directly causes release of Ca in the muscle cells or if it just elicits enough ACh release to overcome the nmj blockade.

 

[W222]

Go back and read how NDMBs work and think about why you would see twitching with electro cautery. I don't mean to be a smart@ss but this is a basic of anesthesia you should know.