Response differences of paretic and healthy extremities to pancuronium and neostigmine in hemiplegic patients

The purpose of this study was to examine differences in train-of-four (TOF) ratios between paretic and healthy extremities after pancuronium and neostigmine administration in 31 patients with hemiparesis. The TOF ratios on the paretic side after pancuronium administration were greater than those on the healthy side in all patients. Patients were classified according to the size of the difference in the TOF ratio on both sides. In group 1, differences in TOF ratios were greater than 20%, and in group 2, they were less than 20%. Fifteen of 17 patients in group 1 had hemiparesis for over three weeks, and in group 2, 10 of 14 patients had hemiparesis for less than three weeks. Patients with flaccid hemiparesis were distributed equally in both groups, while all patients with spastic hemiparesis belonged to group 1. The difference in increase in TOF ratios after neostigmine was the same as the difference in decrease produced by pancuronium.