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A920
October 18, 2010
9:00:00 AM - 11:00:00 AM
Room Hall B1-Area G
Which Neuromuscular Monitoring Mode at the P6 Acupoint Is Most Useful for Preventing PONV?
  **   Kyo S. Kim, Ph.D., M.D., Hee J. Lee, M.D., Jae C. Shim, Ph.D., M.D.
Anesthesiology and Pain Medicine, Hanyang University Hospital, Seoul, Korea
Background. The purpose of this study was to identify the neuromuscular monitoring mode at the P6 acupoint that was the most effective for preventing postoperative nausea and vomiting (PONV) and to determine whether neuromuscular responses over the median nerve were comparable to those over the ulnar nerve.

Methods. In this prospective, double-blind, randomized control trial, 264 women undergoing laparoscopic hystrectomy were evaluated for incidence of PONV. Neuromuscular blockade was monitored by acceleromyography with either a 1 Hz single twitch (ST) over the ulnar nerve (n = 54, control), and 1 Hz ST (n = 52), train-of-four (TOF) (n = 53), double-burst stimulation (DBS) (n = 53), or tetanus (n = 52) over the median nerve, respectively. In 20 patients, TOF and ST stimulation were used to evaluate the neuromuscular block after rocuronium over the ulnar or median nerve simultaneously.

Results. The incidence of PONV after tetanus (28.8%) was significantly reduced compared to control (70.4%), ST (55.8%) and TOF (58.5%) (P < 0.05).[table1]In Bland and Altman analysis, the bias (upper and lower limits of agreement) for the TOF ratio was 0.07 (-0.24 and +0.38); for the ST ratio, it was 0.26 (-0.47 and +0.99). The overestimated values of the median nerve compared with the ulnar nerve were 16.2% of the TOF ratio and 72.9% of the ST ratio.[figure1]Conclusions. Tetanus applied at the P6 acupoint can most effectively reduce PONV compared to other neuromuscular monitoring modes. The ulnar and median nerve cannot be used interchangeably for neuromuscular monitoring.

From Proceedings of the 2010 Annual Meeting of the American Society Anesthesiologists.
Table 1 Incidences of nausea and vomiting at 8 and 24 hours after surgery.
 ControlSTTOFDBSTetanus
n5452535352
PONV at 8h     
Nausea, n (%)15 (27.8)*14 (26.9)*15 (28.3)*10 (18.9)5 (9.6)
Vomiting, n (%)14 (25.9)*9 (17.3)*10 (18.9)*7 (13.2)4 (7.7)
Total PONV, n (%)29 (53.7)*23 (42.6)*25 (47.2)*17 (32.1)9 (17.3)
Rescue antiemetics, n (%)16 (29.6)*10 (19.2)*14 (26.4)*11 (20.8)5 (9.6)
PONV at 24 h     
Nausea, n (%)22 (40.7)*17 (32.7)*19 (35.8)*13 (24.5)8 (15.4)
Vomiting, n (%)16 (29.6)*12 (23.1)*12 (22.6)*9 (17.0)7 (13.5)
Total PONV, n (%)38 (70.4)*29 (55.8)*31 (58.5)*22 (41.5)15 (28.8)
Rescue antiemetics, n (%)17 (31.5)*15 (28.8)*15 (28.3)*13 (24.5)8 (15.4)
Total fentanyl administered, (micro gm)430.1 (42.5)402.5 (47.5)401.3 (43.8)403.6 (45.1)401.5 (44.8)
*P<0.05 compared with the Tetanus group.
Figure 1