Application of muscle ultrasound in amyotrophic lateral sclerosis / 中华神经科杂志

Amyotrophic lateral sclerosis (ALS) is one of the fatal neurodegenerative diseases. Muscle ultrasound can be used in ALS to make early diagnosis, strengthen disease management and differentiate other neuromuscular diseases from it. In ALS patients, morphological changes such as muscle atrophy, increased echo intensity and fasciculation can be detected by muscle ultrasound which is helpful in assessing respiratory and swallowing functions as well. High frequency ultrasound has the clinical value in the diagnosis, monitoring and prognosis evaluation of ALS patients.

Fasciculaciones y calambres: bases fisiológicas y enfrentamiento clínico de un fenómeno complejo

Fasciculations and cramps originate in the motor unit, a functional unit that includes the lower motor neuron and their innervated muscle fibres. Both are common complaints in outpatient practice. These symptoms can be secondary to neurological or medical pathology, presenting a broad differential diagnosis and a complex approach. Recent neurophysiological studies have increased the knowledge of their origin mainly in amyotrophic lateral sclerosis. The symptomatic management of fasciculations and cramps depends on their etiology and includes pharmacological and non-pharmacological treatments. This article aims to present an updated review of the most relevant aspects of physiopathology, clinical approach, and differential diagnosis of both phenomena.

Effect of physical exercise on increasing the maximum oxygen uptake of skeletal muscle / O efeito do exercício físico no aumento de captação máxima de oxigênio do musculo esquelético / El efecto del ejercicio físico en el aumento de consumo máximo de oxígeno del músculo esquelético

ABSTRACT Introduction: Aerobic exercise can improve the physical function of athletes and increase the oxygen content in skeletal muscles. This has a significant reference value for evaluating training effects and judging sports fatigue. Objective: Maximum oxygen uptake is one of the most critical indicators of aerobic work capacity. The thesis analyzes the medical promotion effect of physical exercise on the oxygen content of skeletal muscle. Methods: The thesis performed aerobic exercises on two groups of young rowers. Athletes in group A performed high-load exercise, and athletes in group B performed low-load exercise. At the same time, we placed a detector on the athletes' skeletal muscle to test the volunteer's muscle oxygen content and other physiological indicators. Results: Comparing high-load exercise and low-load exercise, the maximum oxygen uptake and the utilization rate of the maximum oxygen uptake when reaching the anaerobic net were 10% and 16% higher, respectively. There was no difference in the activity of muscle enzymes between the two groups. Conclusions: After aerobic training, the muscle's oxygen utilization capacity is strengthened. Physical exercise promotes the maximum oxygen uptake of skeletal muscles. Level of evidence II; Therapeutic studies - investigation of treatment results.

RESUMO Introdução: O exercício aeróbico pode melhorar a função física de atletas e aumentar o conteúdo de oxigênio nos músculos esqueléticos. Isso tem valor referencial importante na avaliação de efeitos do treinamento e no julgamento da fadiga pela prática de esportes. Objetivo: A captação máxima de oxigênio é um dos indicadores cruciais da capacidade aeróbica. A tese analisa o efeito médico de se incentivar exercícios físicos para o conteúdo de oxigênio do músculo esquelético. Métodos: a tese realizou exercícios aeróbicos em dois grupos de jovens remadores. Os atletas do grupo A realizaram exercícios de alta carga; os atletas do grupo B realizaram exercícios de baixa carga. Ao mesmo tempo, colocamos um detector nos músculos esqueléticos dos atletas para testar o conteúdo de oxigênio no músculo e outros indicadores fisiológicos. Resultados: Ao compararmos exercícios de alta carga e de baixa carga, a captação máxima de oxigênio e o índice de utilização de captação máxima de oxigênio ao atingir o ganho aeróbico foram 10% e 16% mais altos, respectivamente. Não houve diferença na atividade de enzimas musculares entre os dois grupos. Conclusões: Após o treino aeróbico, a utilização de oxigênio do músculo se fortalece. O exercício físico promove a máxima captação de oxigênio dos músculos esqueléticos. Nível de evidência II; Estudos terapêuticos - investigação de resultados de tratamento.

RESUMEN Introducción: El ejercicio aeróbico puede mejorar la función física de atletas y aumentar el contenido de oxígeno en los músculos esqueléticos. Eso tiene valor referencial importante en la evaluación de efectos del entrenamiento y al juzgar la fatiga por la práctica de deportes. Objetivo: El consumo máximo de oxígeno es uno de los indicadores cruciales de la capacidad aeróbica. La tesis analiza el efecto médico de incentivar ejercicios físicos para el contenido de oxígeno del músculo esquelético. Métodos: La tesis realizó ejercicios aeróbicos en dos grupos de jóvenes remeros. Los atletas del grupo A realizaron ejercicios de alta carga, y los atletas del grupo B realizaron ejercicios de baja carga. Al mismo tiempo, pusimos un detector en los músculos esqueléticos de los atletas para probar el contenido de oxígeno en el músculo y otros indicadores fisiológicos. Resultados: Al comparar ejercicios de alta carga y de baja carga, el consumo máximo de oxígeno y el índice de utilización del consumo máximo de oxígeno al atingir el gano aeróbico fueron 10% y 16% más altos, respectivamente. No hubo diferencia en la actividad de enzimas musculares entre los dos grupos. Conclusiones: Tras el entrenamiento aeróbico, la utilización de oxígeno del músculo se fortalece. El ejercicio físico promueve el máximo consumo de oxígeno de los músculos esqueléticos. Nivel de evidencia II; Estudios terapéuticos - investigación de resultados de tratamiento.

Ultrasound versus electromyography for the detection of fasciculation in amyotrophic lateral sclerosis: systematic review and meta-analysis / Ultrassonografia versus eletroneuromiografia para o diagnóstico da fasciculação na esclerose lateralamiotrófica: revisão sistemática e meta-análise

Abstract The objective of this study was to determine the diagnostic accuracy of ultrasound and electromyography for the detection of fasciculation in patients with amyotrophic lateral sclerosis and to compare detection rates between the two methods. By searching the Cochrane Library, MEDLINE, Excerpta Medica, and Latin-American and Caribbean Health Sciences Literature databases, we identified studies evaluating the diagnostic accuracy and fasciculation detection rates of ultrasound and electromyography. The Quality Assessment of Diagnostic Accuracy Studies, version 2, and RTI item bank tools were used for the evaluation of methodological quality. Ultrasound, for 10 s or 30 s, had a higher detection rate than did electromyography in all muscles evaluated. The overall detection rate (in patients) did not differ significantly between ultrasound for 10 s and ultrasound for 30 s. The accuracy of ultrasound for 10 s was 70% in muscles and 85% in patients. The accuracy of ultrasound for 30 s was 82% in patients. Ultrasound provided detection rates superior to those achieved with electromyography, independent of the examination time and muscles evaluated.

Resumo O objetivo deste estudo foi determinar a acurácia diagnóstica da ultrassonografia e da eletroneuromiografia para o diagnóstico da fasciculação e comparar suas taxas de detecção. Foram realizadas buscas nas bases de dados eletrônicas Cochrane Library, MEDLINE, Embase e Lilacs, para estudos que avaliam a acurácia diagnóstica e as taxas de detecção da ultrassonografia e eletroneuromiografia. As ferramentas Quality Assessment of Diagnostic Accuracy Studies, versão 2, e RTI item bank foram utilizadas para avaliação da qualidade do método. A ultrassonografia, tanto de 10 s quanto de 30 s, apresentou taxa de detecção superior à eletroneuromiografia em todos os músculos avaliados. A avaliação da taxa de detecção por pacientes não apresentou diferença significativa entre a ultrassonografia de 10 s e 30 s. A acurácia da ultrassonografia de 10 s nos músculos foi de 70%, enquanto nos pacientes foi de 85%. Já na ultrassonografia de 30 s, a acurácia nos pacientes foi de 82%. A ultrassonografia apresentou taxas de detecção superiores à eletroneuromiografia, independentemente do tempo de sua avaliação e dos músculos avaliados.

Usefulness of phrenic nerve conduction study in early diagnosis of isolated respiratory onset amyotrophic lateral sclerosis

Isolated respiratory onset amyotrophic lateral sclerosis (ALS) is a rare clinical manifestation and the diagnosis can be challenging. A 72-year-old man presented with dyspnea and hypercapnia that had started 11 months earlier. A phrenic nerve study was conducted and he was diagnosed promptly with ALS with no significant time delay. The phrenic nerve study is a noninvasive and useful tool in the diagnosis of respiratory onset ALS that can be applied easily in an emergency department.

Establishment of reference values of tongue muscle thickness with ultrasonography measurement and evaluation of tongue fasciculation through the submental way in Chinese healthy adults and its clinical application / 中华神经科杂志

Objective To establish a method which could measure tongue muscle thickness and evaluate the fasciculation of the tongue muscle by submental way ultrasonic detection , and to obtain the reference values of tongue muscle thickness in healthy volunteers , exploring its clinical application in the patients with amyotrophic lateral sclerosis (ALS).Methods In two-hundred healthy volunteers who took physical examination at the Medical Examination Center of Peking University Third Hospital , the tongue thickness was determined by measuring the distance between the upper and lower surfaces of the lingual muscles in the center of the plane perpendicular to the Frankfurt horizontal plane of the frontal section with a 3.5 MHz convex array transducer .The fasciculation of tongue muscle was evaluated using a 7.5 MHz linear array transducer in the same position .This method was used to measure the thickness of tongue muscle and to evaluate tongue muscle fasciculation in 30 patients with ALS who visited neurological clinic with the diagnosis of possible or definite ALS according to revised El Escorial criteria during the same period .We compared the tongue muscle thickness between 30 ALS patients and the same number of age-and gender-matched healthy volunteers .Results The mean value of tongue muscle thickness of males was significantly higher than that of females ((4.09 ±0.52) cm vs (3.70 ±0.56) cm, t=5.108, P<0.01), but there was no significant difference in the tongue muscle thickness between the different age groups .The mean value of tongue muscle thickness was significantly correlated with the body mass index value in healthy subjects ( r=0.412, P<0.01).No tongue muscle fibrillation was detected in healthy volunteers .In ALS group, the tongue was significantly thinner than that in healthy subjects ((3.77 ±0.58) cm vs (4.05 ±0.49) cm, t=-0.253, P<0.05).Of the total 30 ALS patients, we recognized tongue muscle fasciculation in 12 (40%).Conclusion The method to measure tongue muscle thickness and evaluate tongue musclefibrillation is reliable , and has good clinical application value in related diseases such as ALS .

Relationship between paravertebral muscle twitching and long-term effects of radiofrequency medial branch neurotomy

BACKGROUND: To achieve a prolonged therapeutic effect in patients with lumbar facet joint syndrome, radiofrequency medial branch neurotomy (RF-MB) is commonly performed. The purpose of this study was to evaluate the prognostic value of paravertebral muscle twitching when performing RF-MB in patients with lumbar facet joint syndrome. METHODS: We collected and analyzed data from 68 patients with confirmed facet joint syndrome. Sensory stimulation was performed at 50 Hz with a 0.5 V cut-off value. Patients were divided into 3 groups according to the twitching of the paravertebral muscle during 2 Hz motor stimulation: ‘Complete’, when twitching was observed at all needles; ‘Partial’, when twitching was present at 1 or 2 needles; and ‘None’, when no twitching was observed. The relationship between the long-term effects of RF-MB and paravertebral muscle twitching was analyzed. RESULTS: The mean effect duration of RF-MB was 4.6, 5.8, and 7.0 months in the None, Partial, and Complete groups, respectively (P = 0.47). Although the mean effect duration of RF-MB did not increase significantly in proportion to the paravertebral muscle twitching, the Complete group had prolonged effect duration (> 6 months) than the None group in subgroup analysis. (P = 0.03). CONCLUSIONS: Paravertebral muscle twitching while performing lumbar RF-MB may be a reliable predictor of long-term efficacy when sensory provocation under 0.5 V is achieved. However, further investigation may be necessary for clarifying its clinical significance.

Prophylactic use of pregabalin for prevention of succinylcholine-induced fasciculation and myalgia: a randomized, double-blinded, placebo-controlled study / Uso profilático de pregabalina para prevenção de mialgia e fasciculação induzidas por succinilcolina: estudo randômico, duplo-cego e controlado por placebo

ABSTRACT BACKGROUND: Succinylcholine is commonly used to achieve profound neuromuscular blockade of rapid onset and short duration. OBJECTIVE: The present study compared the efficacy of pregabalin for prevention of succinylcholine-induced fasciculation and myalgia. DESIGN: Prospective, randomized, placebo controlled, double blinded study. MATERIALS AND METHODS: Patients of both genders undergoing elective spine surgery were randomly assigned to two groups. Patients in Group P (pregabalin group) received 150 mg of pregabalin orally 1 h prior to induction of anesthesia with sips of water and patients in Group C (control group) received placebo. Anesthesia was induced with fentanyl 1.5 mcg/kg, propofol 1.5-2.0 mg/kg followed by succinylcholine 1.5 mg/kg. The intensity of fasciculations was assessed by an observer blinded to the group allotment of the patient on a 4-point scale. A blinded observer recorded postoperative myalgia grade after 24 h of surgery. Patients were provided patient-controlled analgesia with fentanyl for postoperative pain relief. RESULTS: Demographic data of both groups were comparable (p > 0.05). The incidence of muscle fasciculation's was not significant between two groups (p = 0.707), while more patients in group C had moderate to severe fasciculation's compared to group P (p = 0.028). The incidence and severity of myalgia were significantly lower in group P (p < 0.05). CONCLUSION: Pregabalin 150 mg prevents succinylcholine-induced fasciculations and myalgia and also decreases the fentanyl consumption in elective sine surgery.

RESUMO JUSTIFICATIVA: A succinilcolina é comumente usada para atingir um bloqueio neuromuscular profundo, de início rápido e de curta duração. OBJETIVO: Comparar a eficácia de pregabalina na prevenção de mialgia e fasciculação induzidas por succinilcolina. DESENHO: Estudo prospectivo, randômico, duplo-cego e controlado por placebo. MATERIAIS E MÉTODOS: Pacientes de ambos os sexos submetidos a cirurgia eletiva de coluna foram aleatoriamente divididos em dois grupos. Os pacientes do Grupo P (pregabalina) receberam 150 mg de pregabalina oral uma hora antes da indução da anestesia e os pacientes do Grupo C (controle) receberam placebo. A anestesia foi induzida com fentanil (1,5 mcg/kg) e propofol (1,5-2,0 mg/kg), seguidos de succinilcolina 1,5 mg/kg. A intensidade da fasciculação foi avaliada por um observador, cego para a alocação dos grupos, com uma escala de 4 pontos. Um observador cego registrou o grau pós-operatório de mialgia após 24 horas de cirurgia. Para o alívio da dor no pós-operatório, fentanil foi usado em sistema de analgesia controlada pelo paciente. RESULTADOS: Os dados demográficos de ambos os grupos eram comparáveis (p > 0,05). A incidência de fasciculação muscular não foi significativa entre os dois grupos (p = 0,707), enquanto mais pacientes do Grupo C apresentaram fasciculação de moderada a grave em relação ao Grupo P (p = 0,028). A incidência e a gravidade da mialgia foram significativamente menores no grupo P (p < 0,05). CONCLUSÃO: Pregabalina (150 mg) previne mialgia e fasciculação induzidas por succinilcolina, além de diminur o consumo de fentanil em cirurgia eletiva de coluna.

Optimal precurarizing dose of rocuronium to decrease fasciculation and myalgia following succinylcholine administration / 대한마취과학회지

BACKGROUND: Succinylcholine commonly produces frequent adverse effects, including muscle fasciculation and myalgia. The current study identified the optimal dose of rocuronium to prevent succinylcholine-induced fasciculation and myalgia and evaluated the influence of rocuronium on the speed of onset produced by succinylcholine. METHODS: This randomized, double-blinded study was conducted in 100 patients randomly allocated into five groups of 20 patients each. Patients were randomized to receive 0.02, 0.03, 0.04, 0.05 and 0.06 mg/kg rocuronium as a precurarizing dose. Neuromuscular monitoring after each precurarizing dose was recorded from the adductor pollicis muscle using acceleromyography with train-of-four stimulation of the ulnar nerve. All patients received succinylcholine 1.5 mg/kg at 2 minutes after the precurarization, and were assessed the incidence and severity of fasciculations, while myalgia was assessed at 24 hours after surgery. RESULTS: The incidence and severity of visible muscle fasciculation was significantly less with increasing the amount of precurarizing dose of rocuronium (P < 0.001). Those of myalgia tend to decrease according to increasing the amount of precurarizing dose of rocuronium, but there was no significance (P = 0.072). The onset time of succinylcholine was significantly longer with increasing the amount of precurarizing dose of rocuronium (P < 0.001). CONCLUSIONS: Precurarization with 0.04 mg/kg rocuronium was the optimal dose considering the reduction in the incidence and severity of fasciculation and myalgia with acceptable onset time, and the safe and effective precurarization.

Remifentanil Attenuates Muscle Fasciculations by Succinylcholine

PURPOSE: The present visual and electromyographic study was designed to evaluate muscle fasciculations caused by succinylcholine in adults pretreated with either remifentanil 1.5 microgram/kg or saline. MATERIALS AND METHODS: The effect of remifentanil on succinylcholine-induced muscle fasciculations was studied using a double-blind method in 40 adults. After i.v. pretreatment with either remifentanil 1.5 microgram/kg (remifentanil group, n = 20) or an equivalent volume of i.v. saline (saline group, n = 20), patients were anaesthetized with a 2.0 mg/kg of i.v. propofol followed by i.v. succinylcholine 1.0 mg/kg. Intensity and duration of muscle fasciculation following i.v. succinylcholine administration were recorded. Electromyography (EMG) was used to quantify the extent of muscle fasciculation following i.v. succinylcholine injection. Myalgia was evaluated 24 hours after induction time. Serum potassium levels were measured five minutes after i.v. succinylcholine administration and creatine kinase (CK) levels 24 hours after induction time. RESULTS: Compared to saline treated controls, remifentanil decreased the intensity of muscle fasciculations caused by i.v. succinylcholine [fasciculation severity scores (grade 0 to 3) were 2/1/12/5 and 3/13/4/0 (patients numbers) in the saline group and the remifentanil group, respectively, p < 0.001]. The mean (SD) maximum amplitude of muscle action potential (MAP) by EMG was smaller in the remifentanil group [283.0 (74.4) microV] than in the saline group [1480.4 (161.3) microV] (p = 0.003). Postoperative serum CK levels were lower in the remifentanil group (p < 0.001). Postoperative myalgia was not different between the two groups. CONCLUSION: Remifentanil 1.5 microgram/kg attenuated intensity of muscle fasciculations by succinylcholine.

Optimal Time Interval of Rocuronium Pretreatment for Prevention of Biochemical Changes, Fasciculations and Myalgia Following Succinylcholine Administration / 대한마취과학회지

BACKGROUND: The purpose of this study was to assess the optimal time interval between rocuronium pretreatment and succinylcholine for prevention of the rise in serum potassium and creatine kinase concentrations and the increased incidence of fasciculations and myalgia following succinylcholine administration. METHODS: We have studied 60 patients undergoing a minor elective surgery, in a prospective double blinded method. Three groups of 20 patients each were pretreated with saline 2 ml (Group C), 0.05 mg/kg rocuronium one min before (Group R1) or 3 min before (Group R3) 1.5 mg/kg succinylcholine administration. Serum potassium and creatine kinase were respectively measured 5 min after succinylcholine and 24 h after the operation. Fasciculations and myalgia on postoperative day 1 and day 2 were evaluated. RESULTS: The increase in the serum potassium concentration was not attenuated in any group. The increase in creatine kinase concentration, the incidence of fasciculations and the incidence of myalgia on postoperative day 1 and day 2 were highest in Group C; however, there was no difference between the Group R1 and R3. CONCLUSIONS: Either a 1 min or 3 min pretreatment time interval of the rocuronium has a similar effect on the prevention of the rise in serum potassium and creatine kinase concentrations and an increased incidence of fasciculations and myalgia following succinylcholine administration.

Rocuronium and Lidocaine Pretreatment for Prevention of Biochemical Changes, Fasciculations and Myalgia following Succinylcholine Administration / 대한마취과학회지

BACKGROUND: The purpose of this study was to assess the changes in serum potassium and creatine kinase concentrations and the incidence of fasciculations and myalgia when rocuronium and lidocaine were used in combination and separately as pretreatment before succinylcholine. METHODS: We studied 60 patients undergoing a minor elective surgery, in a prospective double blinded method. Three groups each with 20 patients were pretreated before a 1.5 mg/kg succinylcholine administration with 0.05 mg/kg rocuronium three min before (group R), 1.5 mg/kg lidocaine 30 sec before (group L), or both rocuronium and lidocaine (group RL). Serum potassium and creatine kinase were respectively measured 5 min after succinylcholine administration and 24 h after the operation. Fasciculations and myalgia on postoperative day 1 and day 2 were evaluated. RESULTS: The increase in creatine kinase and incidence of myalgia on postoperative day 1 was less in the RL group than in the R group and L group. The incidence of fasciculations was higher in the L group than in the R group and RL group. There was no increase in serum potassium in any group. CONCLUSIONS: The combined use of rocuronium and lidocaine was more effective in reducing creatine kinase and postoperative myalgia than when they were used separately. However, the fasciculations were only reduced by the use of rocuronium.

Succinylcholine-Induced Fasciculation is Prevented by Mivacurium-Precurarization / 대한구급학회지

BACKGOUND: Succinylcholine (SCC) injection may be associated with adverse effects including elevated serum potassium (K ) and creatinine phosphokinase (CPK) level, and postoperative myalgia. Many studies have been made to prevent these adverse effects such as pretreatment with non-depolarizing muscle relaxants. The effects of the pretreatment with vecuronium or mivacurium, a new non-depolarizing neuromuscular blocker, on SCC-induced fasciculation, serum K and CPK level was investigated in this study. METHODS: ASA physical status I or II, 40 patients were allocated randomly into 4 groups. Group I as a control group received SCC 1 mg/kg only, while the other groups were pretreated with vecuronium 0.02 mg/kg (0.4 x ED95) (group II), mivacurium 0.02 mg/kg (0.25 x ED95) (group III) and 0.03 mg/kg (0.4 x ED95) (group IV) before the SCC 1.5 mg/kg injection, respectively. Serum K concentration was measured just before anesthetic induction and 5 minute after SCC injection, and serum CPK was estimated before induction and at 24~36 hours postoperatively. And the fasciculation after SCC injection was graded by Cullen's suggestion. RESULTS: Serum K concentration was increased in group I and decreased in pretreated groups, but the difference was not significant within each group and between the groups. Serum CPK level was increased in group I, II and IV but these changes were also insignificant between all groups. The grade of SCC-induced fasciculation was attenuated in group II and IV (p<0.05). CONCLUSIONS: Like vecuronium, mivacurium 0.03 mg/kg is effective to reduce fasciculation after SCC injection, but 0.02 mg/kg is not. However, any complication does not occur in the two dosages.

The Evaluation of Postoperative Myalgia after Administration of Succinylcholine and the Effect of Pancuronium Pretreatment / 대한마취과학회지

BACKGROUND: Postoperative myalgia after administration of succinylcholine is a frequent complication after surgery. This study was designed to determine whether there was any association between postoperative myalgia and muscle relaxants. METHODS: Sixty patients were assigned to three groups of equal size. Group 1, the patients received succinylcholine, 1.0 mg/kg for tracheal intubation. Group 2, received pancuronium 0.01 mg/kg, 4 minutes before administration of succinylcholine 1.5 mg/kg. Group 3, received pancuronium 0.01 mg/kg, 4 minutes before administration of pancuronium 0.09 mg/kg. Blood samples for determination of serum potassium concentration were taken before the induction of anesthesia and 3 minutes after tracheal intubation. The incidence and severity of muscle fasciculation and myalgia were assessed in a double-blind manner. RESULTS: Serum potassium concentration was significantly increased in group 1. In group 2, incidence and severity of muscle fasciculation were significantly less than groups 1. Postoperative myalgia was significantly less in group 3 when compared with group 1 and 2. CONCLUSIONS: There was no significant correlation between succinylcholine induced fasciculation and postoperative myalgia. Pretreatment with pancuronium decreased the incidence of fasciculation and the changes of serum potassium concentration by succinylcholine, but has little effects on the succinylcholine induced postoperative myalgia.

Effect of thiopentone, midazolam, etomidate and propofol on the serum potassium increase, muscle fasciculations and myalgia following suxamethonium administration / 中华麻醉学杂志

Objective To investigate the influence of thiopentone, midazolam, etomidate and propofol on the suxamethonium-induced serum potassium increase, muscle fasciculations and myalgia Methods Sixty patients, ASA class Ⅰ-Ⅱ were allocated randomly to receiving intravenous thiopentone 5mg/kg(thiopentone-group), midazolam 0.3mg/kg( midazolam-group), etomidate 0.3mg/kg(etomidate-group)or propofol 2mg/kg(propofol-group) respectively, followed by intravenous suxamethonium and tracheal intubation. Serum potassium concentration was measured before induction and intubation and after intubation. The incidences of muscle fasciculation during induction and postoperative mylgia were observed .Results As compared with that before induction ,the serum potassium levels in thiopentone- and etomidate-group increased significantly by 3.4% and 5.3% respectively after induction (P0.05).The incidences of muscle fasciculation and postoperative myalgia inmidazolam- and propofol -group were significantly lower than in thiopentone- and etomidate -group (P

The Effect of Diazepam and Midazolam Pretreatment on Succinylcholine Induced Fasciculation , Muscle Relaxation and Serum Potassium and Creatine Phosphokinase Changes / 대한마취과학회지

It has been already reported that diazepam pretreatment attenuated succinylcholine(Sch)-induced myalgia, fasciculation and potassium elevation. The effect of midazolam, a benzodiazepine derivative like diazepam, on Sch has not been investigated. So Midazolam, d-Tubocurarine and diazepam pretreatment were studied to determine the effect on subsequently administered Sch in 36 female patients. The patients were divided into 4 groups. Group 1 received no pretreatment, only Sch 1mg/kg(control). While Group 2 received d-Tubocurarine 0.05mg/kg, Group 3 received diazepam 0.05 mg/kg, and Group 4 received midazolam 0.025 mg/kg. After the pretreatment 4 minutes before Sch administration, the time to abolition and recovery of twitch height, the degree of fasciculation, the adequacy of relaxation for intubation, the changes in serum potassium and creatine pliosphokinase(CPK) were measured. The results are as follows: I) Group 2 showed increased time to abolition of twitch and decreased time to recovery of twitch. Group 3 showed increased time to recovery of twitch. 2) The incidence of fasciculation was decreased in Groups 2, 3 and 4. 3) Serum potassium was increased in Groups 1 and 2 but not in Groups 3 and 4. 4) Serum creatine phosphokinase was in- creased in all groups at post-Sch. 24 hours. It is concluded that diazepam and midazolam pretreatment attenuate Sch-inducedifasciculation and potassium increase.

What`s the optimal timing of pretreatment with pancuronium before succinylcholine to prevent muscle fasciculation? / 대한마취과학회지

Succinylcholine(SCh)-induced muscle fasciculations may be prevented by pretreatment with small doses of nondepolarizing muscle relaxants. The optimal timing of pretreatment to abolish fasciculation varies according to the drug used and dose. In this study, we determined the optimal timing of pretreatment of pancuronium to prevent muscular fasciculation in 100 patients. Each group (n=20) was received pancuronium 0.015 mg/kg at 1, 2, 3, 4, 5 minutes before SCh 3 mg/kg administration, respectively. The degree of fasciculations after SCh administration was observed and classified into one of 4 grade. There were significant differences between each groups (Ridit scores=10.078, p<0.01) To compare observed fasciculations of one grpup with those of the others, the degree of fasciculations was summed according to an arbitrary scale. The summation of grade in 4 minute group was lowest in this scale. It was concluded that the optimal timing of pretreatment, pancuronium 0.015 mg/kg, was 4 minutes before SCh 3 mg/kg injection.

The Effects of Non - depolarizing Neuromuscular Blockers on the Succinylcholine Induced Muscle Fasciculation , Postoperative Musle Pain and Relaxation / 대한마취과학회지

To study the effects of small amounts of non-depolarizing neuromuscular blockers on the muscle fasciculation, postoperative muscle pains and relaxation time by succinylcholine, three groups of patients were pretreated with vecuronium (0.01 mg/kg), pancuronium (0.015 mg/kg) and gallamine (0, 2 mg/kg) 3 minutes before succinylcholine injection, respectively and compared their results with control group-saline pretreated group. The results are as follows; 1) Intensity of muscle fasciculation deereased significantly in all groups with non-depolarizing neuromuscular blockers, and frequency had the fewest in pancuronium pretreated group than the others. 2) Intensity of postoperative muscle pains decreased significantly in groups pretreated with pancuronium and gallamine, and frequency had the fewest in gallamine pretreated group than the others. 3) Pretreatment with non-depolarzing neuromuscular blocker had no effects on the onset time of muscle relaxation of succinylcholine but recovery of muscle relaxation by succinylchoine was more rapidly occured than control group. Above results, it will be suggest that gallamine and pancuronium can be used more effectively to prevent muscle fasciculation and postoperative muscle pain without influence on succinylcholine-induced muscle relaxation.