Comparison of cisatracurium-induced neuromuscular block at the masseter and adductor pollicis muscle

Abstract

Adequate relaxation of the masseter muscle is important during endotracheal intubation and for the patency of a patient’s airway during recovery from anaesthesia. We evaluated onset and recovery from cisatracurium-induced neuromuscular block at the masseter and adductor pollicis muscles. Thirty patients were randomly allocated to receive either 0.1 or 0.15 mg kg⁻¹ cisatracurium. The evoked response was measured at both muscles using acceleromyography. Onset time was significantly shorter at the masseter muscle than at the adductor pollicis (0.1 mg kg⁻¹ cisatracurium: 155±52 vs. 229±44 s; 0.15 mg kg⁻¹ cisatracurium: 105±24 vs. 174±35 s). Following 0.1 mg kg⁻¹ cisatracurium, recovery to a TOF-ratio of 0.7 was faster at the masseter compared to the adductor pollicis (P < 0.05). In the 0.15 mg kg⁻¹ cisatracurium group recovery of T₁ to 75% of control and to a TOF-ratio of 0.7 occurred sooner at the masseter (P < 0.05). We conclude that onset and recovery from cisatracurium neuromuscular block occurs more rapidly at the masseter than at the adductor pollicis. It appears unlikely that residual paralysis is present at the masseter once neuromuscular function at the adductor pollicis has completely recovered.