• H Iwasaki, M Yamauchi, E Narimatsu, M Yamakage, H Tsuchida, and A Namiki.
• Department of Anesthesiology, Sapporo Medical University, School of Medicine, Japan.
• Can J Anaesth. 1997 Nov 1;44(11):1208-10.

PurposeTo evaluate the onset of vecuronium neuromuscular blockade in the hand with an arterio-venous shunt for haemodialysis.MethodsIn 15 adult patients receiving haemodialysis for renal failure the onset of vecuronium-induced neuromuscular blockade after 0.08 mg-kg-1 vecuronium i.v. was measured. Using train-of-four mechanomyographic monitoring, the force of contraction of the adductor pollicis of both hands with and without arterio-venous shunt was measured simultaneously.ResultsThe times from the injection to the first depression of twitch response (latent onset) and 95% twitch depression (onset) in the hand with and without arterio-venous shunt were 114.7 +/- 33.4 and 218.7 +/- 59.9 and 117.3 +/- 34.3 and 208.7 +/- 60.9 sec respectively. No difference in the onset of vecuronium neuromuscular blockade in the hand an arterio-venous shunt was demonstrated.ConclusionThe presence of an arteriovenous fistula does not modify the onset on neuromuscular blockade. Either arm can be used to monitor onset of neuromuscular blockade in chronic renal failure patients with an arterio-venous shunt in the hand for haemodialysis.

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