AUTHOR=Soffer Omri David , Kim Angela , Underwood Ellen , Hansen Anne , Cornelissen Laura , Berde Charles 

TITLE=Neurophysiological Assessment of Prolonged Recovery From Neuromuscular Blockade in the Neonatal Intensive Care Unit

JOURNAL=Frontiers in Pediatrics

VOLUME=8

YEAR=2020

URL=https://www.frontiersin.org/journals/pediatrics/articles/10.3389/fped.2020.00580

DOI=10.3389/fped.2020.00580

ISSN=2296-2360

ABSTRACT=<p><bold>Objective:</bold> To evaluate recovery from neuromuscular blockade in infants using Train-of-Four nerve stimulation.</p><p><bold>Study Design:</bold> Ulnar nerve stimulation was used to evoke thumb twitch and reported as Train-of-Four ratio. Thumb twitch was also recorded visually in real-time. Primary outcome was time to near recovery of muscle function (Train-of-Four ratio &gt;70%). Secondary analyses were time to greater degrees of recovery (Train-of-Four ratio &gt;80, 90%), sensitivity of accelerometry vs. visual thumb-twitch and clinical variates to assess safety.</p><p><bold>Results:</bold> Patients were enrolled following rocuronium-boluses (<italic>n</italic> = 10) and vecuronium-infusions (<italic>n</italic> = 9). Median recovery time to Train-of-Four ratio &gt;70% was 14 h following rocuronium-bolus dosing and 34 h following cessation of continuous vecuronium infusion. Median stimulus threshold for accelerometry was 27.5 mA and visual observation was 20 mA. There were no safety concerns.</p><p><bold>Conclusion(s):</bold> Neuromuscular monitoring using Train-of-Four nerve stimulation is feasible in infants. Some infants exhibited prolonged recovery from neuromuscular-blockade. These pilot data may facilitate future standardized pediatric protocols on neuromuscular monitoring for safer dosing.</p>