Inspiratory Muscle Strength in Chagas Cardiomyopathy: A Systematic Scoping Review

ABSTRACT The increase in inflammatory markers associated with persistent chronic fibrosing myocarditis, a characteristic of chronic Chagas disease, can result in a reduction in inspiratory muscle strength (IMS) in Chagas cardiomyopathy (CC). However, literature in this field is still scarce. This review aimed to map and summarize the evidence regarding IMS in patients with CC. The inclusion criteria included reports with adult participants with a CC diagnosis, with or without heart failure (HF). The core concept examined was the maximum inspiratory pressure evaluated in the untrained and trained groups in the pre-training period. The context was open, including but not limited to hospitals and health centers. Two authors independently identified eligible studies and extracted the data. Descriptive synthesis was used as the primary strategy for analyzing the results. Nine studies (five clinical trials, three cross-sectional, and one cohort) were included. The CC classification differed among the studies, with no mention of HF in five and no CC staging specification in six. IMS was assessed using a manovacuometer, and only six studies analyzed and interpreted the data concerning the predicted values. The CC population with HF appeared to have impaired IMS. All studies involved only Brazilian volunteers. In conclusion, randomized clinical trials evaluating IMS and the effects of inspiratory muscle training need to be conducted to better understand the prevalence and risk of inspiratory muscle weakness in the CC population, as well as the effects of training. Such studies should be conducted at different stages of CC in different populations and countries.

Assessment of ventilatory function in patients with spinocerebellar ataxia type 2 / Avaliação da função ventilatória em pacientes com ataxia espinocerebelar tipo 2

Abstract Subclinical ventilatory dysfunction is observed in individuals with spinocerebellar ataxias (SCA). No studies have correlated ventilatory dysfunction to clinical and functional decline in SCA2. Objective: To evaluate the relationship between the values of peak expiratory flow (PEF), maximum inspiratory pressure (MIP), and presence of respiratory complaints with age, disease duration, age at onset of symptoms, balance scores, independence in basic (ADL) and instrumental (IADL) Activities of Daily Living (ADLs), and severity of ataxia (SARA) in individuals with SCA2. Methods: Cross-sectional study evaluating age, disease duration, age at onset of symptoms, scores in the Berg Balance Scale and in the SARA, Functional Independence Measure and Lawton's scale, values of PEF and MIP, and the presence of respiratory complaints. Results: The study included 36 individuals with SCA2, with a mean age of 42.5±2.4 years, disease duration of 7.6±8.2 years, age 33.7±11.5 years at onset of symptoms, and 9.9±10.3 points in the SARA scale. The lowest PEF values correlated with the longer disease duration (p=0.021). The lowest values of PEF and MIP correlated with greater balance impairment (p=0.019 and p=0.045, respectively), increased degree of dependence in the ADL (p=0.006 and p=0.050, respectively) and IADL (p=0.003 and p=0.001, respectively) scales, and highest severity of ataxia (p=0.00 and p=0.017, respectively). Respiratory complaints were observed in 12 (33.3%) individuals and were not related to age, disease duration, age at onset of symptoms, balance, independence, ataxia severity, or PEF and MIP values. Conclusion: Ventilatory dysfunction, even when asymptomatic, is related to balance impairment, independence, and ataxia severity in individuals with SCA2.

Resumo Disfunção ventilatória subclínica tem sido observada em indivíduos com ataxias espinocerebelares (SCA). Não existem estudos relacionando disfunção ventilatória ao declínio clínico e funcional na SCA2. Objetivo: Avaliar a relação dos valores de Pico de Fluxo Expiratório (PFE), Pressão Inspiratória Máxima (PIMAX) e presença de queixas respiratórias com idade, tempo de doença, idade de início dos sintomas, escore de equilíbrio, independência para atividades básicas (AVD) e instrumentais (AIVD) de vida diária e gravidade da ataxia (SARA) em indivíduos com SCA2. Métodos: Estudo transversal, considerando: idade, tempo de doença, idade de início dos sintomas, escores nas Escalas SARA, Equilíbrio de Berg, Medida da Independência Funcional e de Lawton, valores de PFE, PIMAX e queixas respiratórias. Resultados: Foram avaliados 36 indivíduos com SCA2 com média de 42,5±2,4) anos de idade, 7,6±8,2 anos de tempo de doença, 33,7±11,5 anos de idade de início dos sintomas e 9,9±10,3 pontos na escala SARA. Os menores valores de PFE estiveram relacionados ao maior tempo de doença (p=0,021). Os menores valores de PFE e PIMAX estiveram relacionados ao maior comprometimento do equilíbrio (p=0,019; p=0,045, respectivamente), maior dependência para ADV (p=0,006; p=0,050, respectivamente) e AIVD (p=0,003; p=0,001, respectivamente) e maior gravidade da ataxia (p=0,006; p=0,017, respectivamente). Foram observadas queixas respiratórias em 12 (33,3%) indivíduos que não estiveram relacionadas à idade, idade de início dos sintomas, tempo de doença, equilíbrio, independência, gravidade da ataxia, ou valores de PFE e PIMAX. Conclusão: A disfunção ventilatória, mesmo quando assintomática, está relacionada ao comprometimento do equilíbrio, à independência e à gravidade da ataxia em indivíduos com SCA2.

Correlação entre pressão plantar e força muscular respiratória / Correlation between plantar pressure and respiratory muscle strength

Existem evidências de que alterações posturais possam influenciar no funcionamento da caixa torácica. Além disso, para uma respiração adequada, é necessária boa postura e equilíbrio muscular. O objetivo do presente estudo foi verificar se existe correlação entre a pressão plantar e a força muscular respiratória, visto que ambas sofrem interferência das alterações posturais. Foram avaliados 30 funcionários de uma instituição de Ensino Superior do Médio Paraíba, com idade média de 43,43 ± 13,29 anos, subdivididos em 2 grupos: Grupo experimental (I) e Grupo Controle (II). O grupo I foi submetido a 30 sessões de treinamento muscular respiratório; e ao final da intervenção, ambos os grupos foram reavaliados. Os resultados mostraram que algumas pressões plantares sofreram interferência significativa, com p < 0,05 da força muscular respiratória (PImáx e PEmáx), após o protocolo de exercício, confirmando nossa hipótese sobre a possível associação entre a força muscular respiratória e a pressão plantar, pela correlação positiva apresentada por algumas variáveis avaliadas. (AU)

There are evidences that postural alteration may influence the functioning of the thoracic cage. However, proper breathing requires good posture and muscle balance. The present study aim was to verify whether there is correlation between a plantar pressure and respiratory muscle strength, as both suffer interference of the postural alterations. We evaluated 30 employees from an a higher Education Institution with the average age between 43,43 ± 13,29 years subdivided into two groups: Experimental group (I) and Control group (II). Group I underwent 30 sessions of respiratory muscle training and at the end of the intervention both groups were reevaluated. The results showed that some plantar pressures undergo significant interference with p < 0.05 in respiratory muscle strength (PEmáx e PEmáx) after exercise protocol confirming our hypothesis about the possible association between respiratory muscle strength and plantar pressure by the positive correlation presented by some variables evaluated. (AU)

Incubadora neonatal con ventilación mecánica embebida / Mechanical Ventilation embedded in Neonatal Incubator

RESUMEN Se presenta un equipo de soporte de vida neonatal (ESVIN) que emplea la terapia térmica y terapia ventilatoria (neumática) en un solo equipo para proveer ventilación pulmonar con aire caliente, humedecido y enriquecido con oxígeno, en un ambiente caliente, humidificado y estéril. El equipo es capaz de simultáneamente dar ventilación pulmonar e incubar, siendo una de sus características principales la minimización de la condensación del agua en el corrugado y ofrece la característica adicional de evitar la movilización y/o desconexión del neonato para realizar ciertos procedimientos tales como: cirugías e intubaciones, entre otras. Los principales resultados son el tiempo de acceso al neonato menor a 2 s y minimización de la condensación de agua. Asimismo, los resultados del control térmico son de tiempo de estabilización en el habitáculo de 75 minutos para la temperatura de 36 °C y tiempo de estabilización de la temperatura de la piel del neonato de 58 minutos.

ABSTRACT A neonatal life support equipment (ESVIN) employing simultaneously thermal therapy and ventilatory (pneumatic) therapy is presented in a single kit to provide pulmonary ventilation with warm, moistened and oxygen enriched air in a warm, humidified and sterile environment. The invention behind ESVIN provided simultaneously pulmonary ventilation and incubation having optimized the minimization of water condensation in the corrugated pipe and offered the additional feature of avoiding the mobilization and / or disconnection of the neonate to perform certain procedures such as: surgeries and intubations, among others. ESVIN has an access to newborns of less than 2 s and non-visible water condensation. The main results in thermal control were a stabilization time in the newborn compartment of 75 minutes for the temperature of 36 °C and a stabilization of the temperature of the skin of the neonate of 58 minutes.

Influencia del polimorfismo inserción / deleción (rs4646994) del gen de la enzima convertidora de angiotensina en la presión inspiratoria y espiratoria máxima de jóvenes chilenos sedentarios / Influence of the polymorphism insertion / deletion (rs4646994) of the angiotensin converting enzyme (ACE) gene on maximum inspiratory and expiratory pressure of Chilean sedentary youth

RESUMEN: La expresión de los genes puede impactar sobre el rendimiento muscular. En este aspecto el polimorfismo del gen de la Enzima Convertidora de Angiotensina (ECA), dependiendo de su inserción (Ins) o deleción (Del) puede potenciar diferentes cualidades musculares. Del mismo modo, si consideramos la ventilación como un proceso vital, sería relevante investigar si existe una influencia de este polimorfismo sobre los músculos que llevan a cabo tan importante función. El objetivo de este trabajo consistió en determinar el rendimiento muscular inspiratorio y espiratorio según alelos y polimorfismos del gen de la ECA. Se sometió a 83 sujetos (18 a 35 años), 46 hombres y 37 mujeres, a evaluaciones de capacidad vital forzada (CVF), presión inspiratoria máxima y presión espiratoria máxima (PIM-PEM). Posterior a esto, la genotipificación fue realizada por polimerase chain reaction (PCR) y electroforesis en gel de agarosa. Las variables fueron sometidas al análisis estadístico correspondiente según su distribución paramétrica, el nivel de significancia establecido fue un p<0,05. La distribución genotípica fue: Ins/Ins: 28 %, Ins/Del: 62 % y Del/Del: 19 %. Las mujeres homocigoto Ins, presentaron mayor PIM y PEM en modelos por genotipos (p=0,043; p=0,0001 respectivamente) y por dominancia (p=0,019; p=0,0008 respectivamente). La distribución genotípica y frecuencia alélica fue similar a la descrita anteriormente en población chilena. Además, las mujeres portadoras del alelo Ins, presentaron mayor PIM y PEM.

SUMMARY: Gene expression can impact muscle performance. In this aspect genetic polymorphism of the Angiotensin Converting Enzyme (ACE), depending on its insertion or deletion can strengthen different muscle qualities. Similarly, if we consider ventilation as a vital process, it would be important to research whether or not, there is an influence of this polymorphism on the muscles that perform such an important function. The aim of this study was to determine the inspiratory and expiratory muscle performance according alleles and polymorphisms of the ACE gene. We subjected 83 individuals (18-35 years), 46 men and 37 women, to forced vital capacity evaluations, maximum inspiratory pressure and expiratory pressure. Genotyping was subsequently performed by polymerase chain reaction (PCR) and agarose gel electrophoresis. The variables were subjected to appropriate statistical analysis by parametric distribution, the significance level was set at p <0.05. The genotype distribution was: Ins/Ins: 28 %, Ins/Del: 62 % and Del/Del: 19 %. Women homozygous Ins, exhibited a higher maximum inspiratory pressure and expiratory pressure in models for genotypes (p = 0.043; p = 0.0001 respectively) and for dominance (p = 0.019; p = 0.0008 respectively). The genotype distribution and allele frequency was similar to that described above, in Chilean population. Furthermore, women carrying the Ins allele had a higher maximum inspiratory pressure and expiratory pressure.

Análisis de presión inspiratoria máxima según tres protocolos en estudiantes voluntarios asintomáticos de la Universidad Católica del Maule, Chile / Analysis of maximal inspiratory pressure according to three protocols in asymptomatic volunteer students at the Catholic University of Maule, Chile

Maximum inspiratory pressure (MIP) has been used as an indicator of inspiratory muscle strength. Nevertheless their values show a high variability (~20%). The aim of this study was to determine the MIP, according to three protocols in young subjects. An observational cross-sectional study was carried out on a convenience sample of 60 students, 30 men (19.2 ± 0.81 years-old) and 30 women (19.17 ± 0.91 years-old). MIP was evaluated according to the protocol defined for each group of 20 participants of both genders: Group 1: American Thoracic Society/European Respiratory Society (ATS/ERS); Group 2: Learning; Group 3: Warming. For the analysis we used descriptive and inferential statistics, a p value < 0.05 was considered significant. No differences in MIP were found for the three best averages between groups (p = 0.078). When comparing the total performance of MIP replicates G3 was higher than G1 and G2 (p <0.0001). The coefficient of variation was higher in G2. It is concluded that the warming protocol (G3) could mitigate the effect of learning.

La presión inspiratoria máxima (PIM) ha sido utilizada como indicador de fuerza de la musculatura inspiratoria. No obstante sus valores presentan gran variabilidad (~20%). El objetivo del estudio fue determinar la PIM, según tres protocolos en sujetos jóvenes. Se realizó un estudio observacional de corte transversal en una muestra por conveniencia de 60 estudiantes, 30 hombres (19,2 ± 0,81 años) y 30 mujeres (19,17 ± 0,91 años). Se evaluó la PIM según el protocolo definido para cada grupo compuesto por 20 participantes de ambos géneros: Grupo 1: American Thoracic Society/European Respiratory Society (ATS/ERS); Grupo 2: Aprendizaje; Grupo 3: Calentamiento. Para el análisis se utilizó estadística descriptiva, e inferencial considerándose significativo un valor de p < 0,05. No se encontraron diferencias de PIM de los tres mejores promedios entre grupos (p = 0,078). Al comparar el desempeño total de las repeticiones de PIMG3 fue más alto que G1 y G2 (p < 0,0001). El coeficiente de variación fue más alto en G2. Se concluye que el protocolo calentamiento (G3) podría atenuar el efecto de aprendizaje.

Level of Physical Exercise Capacity, Respiratory Muscle Strength and Peak Expiratory Flow Rate in Healthy Adolescents.

Introduction: The maturation of respiratory system in children leads to changes in value of respiratory parameters like peak expiratory flow rate (PEFR), maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), and 6-minute walk distance (6MWD). Accurate analysis and clinical decisionmaking in disease state require reference values for different ages. The current study was undertaken to study pulmonary function and exercise capacity in children and adolescents. Materials and methods: After obtaining Institutional Ethical approval and parental informed consent, 262 subjects aged 9 to 15 years were recruited for the study. They were divided into two age groups, i.e., preadolescent (9-12 years) and early adolescent (13-15 years). Demographic details including age, sex, height, weight, and body mass index (BMI) were noted. Physical activity rating (PAR) scale was used to denote physical activity levels. Peak expiratory flow rate was measured using standard Mini-bell peak flow meter (PFM). The parameters MIP and MEP was measured using micro respiratory pressure meter, and 6-minute walk test (6MWT) was performed as per American Thoracic Society (ATS) guidelines. Results: A significant difference was noted between the two groups in PEFR, MIP, MEP, and 6MWD (p = 0.00). Age showed a strong positive correlation with PEFR (r = 0.613, p = 0.000), MIP (r = 0.676, p = 0.000), and MEP (r = 0.658, p = 0.00) whereas showed a strong negative correlation with 6MWD (r = -0.605, p = 0.00). Height showed a strong positive correlation with MEP (r = 0.720, p = 0.000) whereas a strong negative correlation with 6MWD (r = -0.42, p = 0.00). Weight showed a weak negative correlation with 6MWD (r = -0.328, p = 0.00). Gender difference was noticeable in 6MWD and PEFR (p = 0.00) but not in MIP (p = 0.45) and MEP (p = 0.44). Almost 22.10% of early adolescents were overweight compared to only 7.7% seen in preadolescent group. Conclusion: PEFR and respiratory muscle strength was higher in early adolescents as compared to pre-adolescents. However, exercise capacity reflected by 6 MWD was found to be lower in early adolescents in comparison to pre-adolescents. These findings could be used while interpreting the outcome measures utilized while treating patients and for goal setting in cardiopulmonary rehabilitation in clinical practice.

Respiratory exercise program for elderly individuals with asthma

INTRODUCTION: Asthma in older adults is frequently underdiagnosed, as reflected by approximately 60 percent of asthma deaths occurring in people older than age 65. OBJECTIVE: The present study evaluates the effects of a respiratory exercise program tailored for elderly individuals with asthma. We are not aware of any other reports examining breathing exercises in this population. METHODS: Fourteen patients concluded the 16-week respiratory exercise program. All the patients were evaluated with regard to lung function, respiratory muscle strength, aerobic capacity, quality of life and clinical presentation. RESULTS: After 16 weeks of this open-trial intervention, significant increases in maximum inspiratory pressure and maximum expiratory pressure (27.6 percent and 20.54 percent, respectively) were demonstrated. Considerable improvement in quality of life was also observed. The clinical evaluations and daily recorded-symptoms diary also indicated significant improvements and fewer respiratory symptoms. A month after the exercises were discontinued, however, detraining was observed. DISCUSSION: In conclusion, a respiratory exercise program increased muscle strength and was associated with a positive effect on patient health and quality of life. Therefore, a respiratory training program could be included in the therapeutic approach in older adults with asthma.

Amyotrophic lateral sclerosis: prospective study on respiratory parameters / Esclerose lateral amiotrófica: estudo prospectivo de parâmetros respiratórios

OBJECTIVE: To verify how efficient respiratory parameters are in the follow-up of subjects with amyotrophic lateral sclerosis (ALS) and to observe possible correlations between respiratory and nutritional functions. METHOD: Sixteen patients with probable or defined ALS were selected and evaluated over eight months using the following respiratory parameters: spirometry, maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), arterial gasometry and pulse oximetry; and nutritional parameters such as body mass index (BMI) and percentage weight loss. RESULTS: PaCO2 was a significant parameter to follow up disease evolution (p=0.051). There was significant correlation between MIP and MEP (r: 0.83); BMI and MIP (r: 0.70); BMI and MEP (r: 0.72); pulse oximetry and forced vital capacity (r: 0.57). CONCLUSION: PaCO2 was shown to be an efficient and significant parameter in the measurement of respiratory impairment; the correlations among MIP, MEP and BMI indicated that these are significant parameters for periodic clinical evaluation.

OBJETIVO: Verificar a eficácia dos parâmetros respiratórios na evolução de indivíduos com esclerose lateral amiotrófica (ELA) e identificar possíveis correlações entre função respiratória e nutricional. MÉTODO: 16 pacientes com diagnóstico provável ou definido de ELA foram selecionados por critérios definidos e avaliados, durante 8 meses, através de parâmetros respiratórios: espirometria, pressão inspiratória máxima (PIM), pressão expiratória máxima (PEM), gasometria arterial e oximetria de pulso; e parâmetros nutricionais: índice de massa corporal (IMC) e porcentagem de perda de peso. RESULTADOS: PaCO2 foi um parâmetro significativo para acompanhar a evolução da doença (p=0.051). Houve correlação significante entre PIM e PEM (r: 0.83); IMC e PIM (r: 0.70); IMC e PEM (r: 0.72); oximetria de pulso e capacidade vital forçada (r: 0.57). CONCLUSÃO: PaCO2 foi marcador eficaz e significante para medir o comprometimento respiratório; correlações entre PIM, PEM e IMC indicaram ser bons parâmetros nas avaliações clínicas periódicas.

Comparação de dois métodos de mensuração da pressão inspiratória máxima em pacientes com e sem alterações do nível de consciência / Comparison of two methods for measurement of maximal inspiratory pressure in patients with and without alterations of the conscience's level

JUSTIFICATIVA E OBJETIVOS: Não existe consenso na literatura sobre o tempo de oclusão das vias aéreas necessário para se obter uma PImax verdadeira durante o desmame da ventilação mecânica (VM). Assim, o presente estudo teve por objetivos comparar dois métodos de mensuração da PImax e avaliar a influência do nível de consciência do paciente nessas medidas. MÉTODO: População composta de 28 pacientes gerais de UTI, com tempo de VM > 48h, em processo de desmame, divididos em dois grupos de acordo com a pontuação na escala de coma de Glasgow (ECGL): com (ECGL< 15) e sem alteração do nível de consciência (ECGL = 15). A via aérea foi ocluída com uma válvula unidirecional por 20s (PImaxT20), ou pelo tempo máximo de um minuto, se um platô de pressão inspiratória não foi observado durante três inspirações consecutivas (PImaxTid). RESULTADOS: A PI Max T20 (média ± DP, cmH2O) foi semelhante em ambos os grupos (44 ± 16 vs 42 ± 15, p = 0,52). No entanto, os valores da PImaxTid, assim como o tempo necessário para sua obtenção, foram maiores no grupo ECGL< 15 (65 ± 24 vs 47 ± 23 cmH2O e 37 ± 10 vs 24 ± 8s, p = 0,04 e 0,0019, respectivamente). CONCLUSÕES: O método comumente utilizado de 20s de oclusão da via aérea parece ser insuficiente para se mensurar a verdadeira PImax em pacientes com alterações do nível de consciência. Estudos adicionais, agora num grupo mais homogêneo de pacientes (p. ex.: com alterações neurológicas estruturais), são necessários para maior esclarecimento destes resultados.

BACKGROUND AND OBJECTIVES: There is no literature consensus about the time of airway occlusion sufficient enough to get a true PImax during weaning from mechanical ventilation (MV). So, the main objectives of the present study were to compare two methods PImax measurement and to evaluate the influence of patients' level of conscience on them. METHODS: The population was composed by 28 general ICU patients, with MV > 48h, in a weaning process, divided into two groups according to Glasgow coma scale score: with (GCS < 15) and without (GCS = 15) alterations of conscience level. The airway was occluded by using an unidirectional valve for 20s (PImaxT20), or for a maximum time of one minute if a plateau of inspiratory pressure was not observed during three consecutive inspirations (PImaxTid). RESULTS: PImaxT20 (mean ± SD, cmH2O) values were similar in both groups (44 ± 16 vs42 ± 15, p = 0.52). However, PImaxTid values, as long as the time needed to their attainment, were greater in GCS < 15 group (65 ± 24 vs 47 ± 23cmH2O and 37 ± 10 vs24 ± 8s, p = 0.04 and 0.0019, respectively). CONCLUSIONS: The method commonly used of 20s airway occlusion seems to be inadequate to get the true PImax in patients with alterations of the level of conscience. Additional studies, now in a more homogeneous group (e. g.: patients with structural brain lesion), are needed to clarify these findings.

Specially Programmed Respiratory Muscle Training for Singers by Using Respiratory Muscle Training Device (Ultrabreathe (R) )

Respiratory muscle training is one of the major methods for enhancing the vocal function. Singers who must use their voice most frequently are well aware of the importance of respiration. However, most of them do not know precisely how to exercise their abdominal respiration. Using a respiratory training device, singers are expected to gain more efficiency in their vocal enhancement. The aim of the study was to examine the pulmonary function, the maximum inspiratory pressure (MIP) and the maximum expiratory pressure (MEP), and the maximum phonation time (MPT) in five female voice-majors students after undergoing specially programmed respiratory muscle training for 2 months. All the voice-majors had an average of 4.8 years of formal classical voice training. A respiratory muscle training device (Ultrabreathe (R) ), Tangent health Care Inc., England) was used to train the respiratory muscle. None of the pulmonary function test variables had changed after respiratory muscle training. However, the MIP, MEP, and MPT were significantly increased higher after the respiratory muscle training. This suggests that the specially programmed respiratory muscle training can improve the respiratory muscle strength and vocal function without increasing the pulmonary function.

Assessment of Adequate Recovery from Vecuronium - Induced Neuromuscular Blockade / 대한마취과학회지

Time to antagonism induced by pyridostigmine from different levels of neuromuscular blockade was evaluated in 45 patients anesthetized with nitrous oxide, fentanyl, and vecuronium. Neuromuscular blockade, as monitered by train-of-four count, was antagonized at varing degrees of spontaneous recovery. Train-of-four ratio was used as an index of the ability of the patients to maintain adequate spontaneous ventil'ation, and maximum inspiratory pressure as an index of the ability of the patients to protect their airways against aspiration or obstruction. We measured time from administration of pyridostigmine to train-of-four ratio of 70% indicating the recovery of the ability to maintain adquate spontaneous ventilation, and time to maximum inspiratory pressure of -45 cmH2O indicating the recovery of the ability to protect the patients airways against aspiration or obstruction. For a train-of-four count level of 0-1, reversal time to train-of-four ratio of 70% was 22.73+/-3.00 minutes and that to maximum inspiratory pressure of -45 cmH2O was 30.33+/-2.69 minutes. For a train-of-four count level of 2- 3, reversal time to train-of-four ratio of 70% was 17.33+/-3.18 minutes and that to maximum inspiratory pressure of -45cmH2O was 22.27+/-2.91 minutes. For a train-of-four count level of 4, reversal time to train-of-four ratio of 70% was 8.40+/-3.58 minutes and that to maximum inspiratory pressure of -45 cmH2O was 14.60+/-3.11 minutes. It is concluded that the more shallow is the neuromuscular blockade, the more rapid and the safer is the reversal of neuromuscular blockade, although the dose of reversal drug was determined according to the depth of neuromuscular blockade. Moreover, it should take more than 30 minutes to antagonixe profaund neuromuacular hlock- ade induced by vecuronium to such a degree that not only can the patients maintain adequate spontaneous ventilation, but they can maintain the airways and protect them against aspiration as well.

Comparison of Maximum Inspiratory Pressure and Train of Four Ratio at Neuromuscular Recovery of Vecuronium after Neuroleptanesthesia / 대한마취과학회지

In this study, we have assessed correlation between maximum inspiratory pressure(MIP) and train of four(TOF) ratio. During neuroleptanesthesia, vecuronium was administered intravenously to 45 patients under TOF monitoring. MIP and TOF ratio was measured every 5 minutes at recovery from neuromuscular blockade. The results were as follows: 1) During neuromuscular recovery, good correlation existed between MIP and TOF ratio. 2) When TOF ratio was 0.65+/-0.05, MIP was 30.4I+/-4.47cmH,O. 3) When TOF ratio was 0.85+/-0.05, MIP was 52.18+/-4.34 cmH,O. These results were suggested that TOF ratio of above 0.8 was consistent with ability to protect the patient's airway against aspiration and obstruction.