Evaluation of Monitoring Neuromuscular Blockade the Flexor Hallucis Compared to the Adductor Pollicis

Study Overview
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Brief Summary
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Current guidelines recommend monitoring of neuromuscular blockade at the adductor pollicis by stimulation of the ulnar nerve at the wrist. However, in certain situations (laparoscopic surgery, cranial surgery or surgical comfort, arterial catheterization), it is impossible to access the patient's wrists, delaying monitoring, antagonizing the neuromuscular block, the emergence from anesthesia and patient extubation , leading in some cases to single injections lack of control of the reversal of the patient. To overcome these technical difficulties, a group nerve / muscle looks interesting and often easily accessible to the anesthesiologist. The stimulation of the posterior tibial nerve can observe a response to the flexor hallucis brevis muscle and allows quick access to monitoring the reversal before the end of the intervention. The primary outcome was to compare the speed of recovery from neuromuscular block flexor hallux versus that of the adductor pollicis. The secondary objective was to compare the speed of installation of deep neuromuscular block flexor hallucis versus that of the adductor pollicis. This is a prospective, exploratory, uncontrolled, single-center for routine care. Are included all aged patients over 18 years, ASA I or II, without guardianship, having no known allergy to Atracurium, without neuromyopathy known, emergency surgery or full stomach, predictable difficult intubation .

Conditions
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Observation of Neuromuscular Block, Flexor Hallucis, Adductor Pollicis

Intervention / Treatment
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* Device: Monitoring Neuromuscular Blockade the Flexor Hallucis
* Device: Monitoring Neuromuscular Blockade adductor of the thumb.


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: over 18 years Any elective surgery with single or multiple injection Atracurium for which hand and foot are accessible at the same time. ASA I or II patients free subject, without guardianship or subordination No opposition given by the patient after information Exclusion Criteria: under 18 years known neuromyopathy Diabetics Emergency surgery and a full stomach predictable difficult intubation Pregnant or breastfeeding women, women of childbearing age who do not have effective contraception

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Diagnostic
Allocation: Non-Randomized
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Monitoring Neuromuscular Blockade<br>Monitoring Neuromuscular Blockade the Flexor Hallucis and adductor of the thumb. | Device: Monitoring Neuromuscular Blockade the Flexor Hallucis<br> <br> Device: Monitoring Neuromuscular Blockade adductor of the thumb.<br> <br> |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Time of occurrence of a T4 / T1 ratio> 0.90 in the train of four flexor hallucis |  | 1 day |