NEUROMUSCULAR AND ELECTROMYOGRAPHIC STUDIES IN MAN: EFFECTS OF HYPERVENTILATION, CARBON DIOXIDE INHALATION AND D-TUBOCURARINE

Hyperventilation-Aided Recovery for Extra Repetitions on Bench Press and Leg Press

Sakamoto, A, Naito, H, and Chow, CM. Hyperventilation-aided recovery for extra repetitions on bench press and leg press. J Strength Cond Res 34(5): 1274-1284, 2020-Hyperventilation (HV)-induced alkalosis, an ergogenic strategy, improved repeated pedaling sprint performance through enhanced H removal. However, it did not confer beneficial effects on other forms of exercises. This study investigated the benefits of HV-aided recovery on lifting repetitions and joint velocity during resistance training involving multiple joints and both concentric and eccentric contractions. Eleven power-trained men (mean ± SD age: 22.5 ± 4.3 years, training experience: 8.3 ± 3.6 years) performed 6 sets each of bench press and leg press at 80% 1 repetition maximum. Each set was continued until failure, with a 5-minute recovery between sets. In protocol A, HV was implemented for 30 seconds before the first, third, and fifth sets of each exercise (HV-aided recovery), whereas spontaneous breathing continued throughout the recovery before the second, fourth, and sixth sets (control recovery). In protocol B, the order of the HV and control recoveries was reversed. For both protocols, reductions in repetitions (range: -4.7% to -22.5%) and velocity (range: -23.1% to -37.7%) were consistently observed after control recovery (p < 0.05), whereas HV-aided recovery resulted in increased repetitions (range: +21.3% to +55.7%) and velocity (range: +6.3% to +15.3%) (p < 0.05) or no reductions in these measures from the previous set. The total repetitions performed across 6 sets (protocols A and B combined) were greater after the HV-aided than control recovery (p ≤ 0.001) in bench press (44 ± 10 vs. 36 ± 10 reps, increased by 27.1 ± 24.1%) and leg press (64 ± 9 vs. 50 ± 15 reps, increased by 35.2 ± 29.5%). Hyperventilation-aided recovery may boost the effectiveness of resistance training through increased training volume and lifting velocity.

Influence of variations in arterial PCO2 on surgical conditions during laparoscopic retroperitoneal surgery

BACKGROUND

Although deep neuromuscular block (post-tetanic-count 1-2 twitches) improves surgical conditions during laparoscopic retroperitoneal surgery compared with standard block (train-of-four 1-2 twitches), the quality of surgical conditions varies widely, often related to diaphragmatic contractions. Hypocapnia may improve surgical conditions. Therefore we studied the effect of changes in arterial carbon dioxide concentrations on surgical conditions in patients undergoing laparoscopic surgery under general anaesthesia and deep neuromuscular block.

METHODS

Forty patients undergoing elective laparoscopic surgery for prostatectomy or nephrectomy received propofol/remifentanil anaesthesia and deep neuromuscular block with rocuronium. Patients were randomized to surgery under hypocapnic or hypercapnic conditions. During surgery, the surgical conditions were evaluated using the 5-point Leiden-Surgical Rating Scale (L-SRS) ranging from 1 (extremely poor conditions) to 5 (optimal conditions) by the surgeon, who was blinded to group.

RESULTS

Mean (sd) arterial carbon dioxide concentrations were 4.5 (0.6) [range: 3.8-5.6] kPa under hypocapnic and 6.9 (0.6) [6.1-8.1] kPa under hypercapnic conditions. The L-SRS did not differ between groups: 4.84 (0.4) [4-5] in hypocapnia and 4.77 (0.4) [3.9-5] in hypercapnia. Ninety-nine percent of ratings were good or excellent irrespective of treatment.

CONCLUSIONS

Deep neuromuscular block provides good to optimal surgical conditions in laparoscopic retroperitoneal urological surgery, independent of the level of arterial [Formula: see text].

CLINICAL TRIAL REGISTRATION

NCT01968447.

Hyper- and hypoventilation affects spinal motor neuron excitability during isoflurane anesthesia

Increasing evidence indicates that the spinal cord is an important site of anesthetic action necessary for surgical immobility. Whether clinical hyper- or hypoventilation affects motor neuron excitability during general anesthesia is unknown. To clarify this issue, we studied seven adult ASA physical status I or II patients undergoing elective surgery. Spinal motor neuron excitability was determined by measuring the posterior tibial nerve H reflex and F wave. The baseline H reflex and F wave were recorded before anesthesia using electrodes placed over the soleus and abductor hallucis muscles. After inhaled induction, the end-tidal isoflurane concentration in O2 was maintained at 0.8%. Ventilation was controlled to maintain a steady-state ETCO2 of 25 +/- 1 and 45 +/- 1 mm Hg randomly for 20 min. Then the H-reflex and F wave were recorded. The difference in H reflex and F wave were analyzed using Student's paired t-test. The baseline H-reflex amplitude (6.8 +/- 2.7 mV) decreased to 4.0 +/- 2.0 mV (P < 0.01) at an ETCO2 of 25 mm Hg and to 2.0 +/- 2.2 mV (P < 0.01) at an ETCO2 of 45 mm Hg. The F-wave persistence (100%) decreased to 77% +/- 24% (P < 0.05) at an ETCO2 of 25 mm Hg and to 61% +/- 19% at an ETCO2 of 45 mm Hg (P < 0.01). Changing ETCO2 values affected H-reflex amplitude and F-wave persistence (P < 0.05), which suggests a change of spinal cord motor neuron excitability, which may affect surgical immobility.

IMPLICATIONS

The spinal cord is important for preventing patient movement during surgery. The likelihood of movement may be predicted by measuring the spinal motor neuron excitability by using the H reflex and F wave. Our results show that intraoperative hyper- and hypoventilation can change the H reflex and F wave, which may affect the probability of patient movement during surgery.

Evaluation of a device for the measurement of the evoked tensions of the rectus abdominis muscle

A device was developed to measure the evoked tensions of the rectus abdominis muscle which consisted of a fluid-filled reservoir wedged between the rectus abdominis muscle and a self-retaining retractor. The evoked contractions of the rectus muscle were compared with that of the tibialis anterior muscle in twelve dogs anaesthetised with pentobarbitone. Significantly greater amounts of tubocurarine were required to depress the response to train-of-four stimuli and the twitch tensions of the rectus muscle than the tibialis. The tibialis recovered faster, spontaneously or after neostigmine, than the rectus in eight of the animals; the opposite occurred in the other four. The present device can be useful during surgery for the evaluation of abdominal muscle tension.

Tranquilizer Effect of Exercise: A Critical Review

In brief: Evidence suggests that none of the currently used tranquilizer drugs can be used without risking side effects and/or addiction. Many people have contended that physical exercise relieves anxiety, but until recently no experimental evidence has supported this subjective conclusion. Dr. deVries examined this hypothesis by reviewing available data and surveys of expert opinion and controlled psychological and physiological experiments. He believes that appropriate types, intensities, and durations of exercise can produce a significant tranquilizer effect. Rhythmic exercise such as walking, jogging, cycling, and bench stepping for 5 to 30 minutes at 30% to 60% of maximum intensity was most effective.

Reversal of non-depolarizing block by neostigmine

Paralysis was maintained in the sheep for 30 or 90 minutes by computer-controlled injection of gallamine, pancuronium, alcuronium or d-tubocurarine, using the integrated electromyogram as a measure of neuromuscular transmission. Neostigmine was given and the recovery time measured. In all trials the recovery rise time was no longer than two minutes, but varied between one and two minutes.

Computer controlled muscle relaxation: a comparison of four muscle relaxants in the sheep

Computer control of anaesthesia has been extended to include muscle relaxant drugs. Injection of d-tubocurarine, gallamine, alcuronium or pancuronium was controlled by computer to reduce the integrated electromyogram to a preset level (40 per cent of control) for one hour. A programmed level of muscle paralysis is therefore possible for use in physiological and pharmacological experiments, and in clinical practice where precise control of the degree of paralysis together with minimal dosage is advantageous.

Anaesthetic considerations in chronic renal failure

This paper discusses the anaesthetic problems presented by patients in chronic renal failure. The anaesthetic agents and techniques used in 181 patients who underwent 941 operations (including 218 renal transplants) are described.