Use of the post-tetanic count to monitor recovery from intense neuromuscular blockade in children.

The post-tetanic count was investigated as a method of monitoring intense neuromuscular blockade in children. One of five myoneural blockers (atracurium, vecuronium, pancuronium, tubocurarine or alcuronium) was given to groups of six children during nitrous oxide-oxygen-halothane anaesthesia. During recovery, the first post-tetanic response always preceded the first train-of-four response. The interval between the appearance of the first post-tetanic response and the first train-of-four response was typically 5-10 min for the intermediate-acting agents vecuronium and atracurium, and 20-30 min for the long-acting agents pancuronium, alcuronium and tubocurarine. A post-tetanic count of 6 with alcuronium and tubocurarine, or 7 with vecuronium, atracurium and pancuronium indicated that recovery of the first train-of-four response was imminent.