To examine the effect of tourniquet use on the duration of rocuronium during fracture fixation of the ankle and hindfoot, addressing a significant knowledge gap.
Key Findings:
Average time to regain at least one twitch in the facial nerve was 34.5 minutes, indicating a potential delay in recovery.
76% of patients recovered 3 or more twitches in the facial nerve before any twitches were recorded in the operative extremity, suggesting a discrepancy in monitoring.
19 patients had 2 or fewer twitches at the extremity during tourniquet inflation, highlighting the impact of tourniquet use.
Interpretation:
The study suggests that monitoring twitches at the facial nerve may not accurately reflect the depth of paralysis in the lower extremity when a tourniquet is inflated, which has important implications for anesthesia practice.
Limitations:
Small sample size of 25 patients may limit generalizability.
Exclusion of patients due to protocol adherence issues or equipment malfunction could introduce bias.
Conclusion:
Tourniquet application significantly affects the monitoring of neuromuscular blockade, indicating that facial nerve twitches may not be reliable for assessing paralysis in the presence of a tourniquet, which is crucial for clinical decision-making.
