Ventilatory response to progressive curarization in patients during light halothane, N2O in O2 anaesthesia

The effects of progressive curarization on spontaneous ventilation were studied in 23 patients during light halothane-nitrous oxide-oxygen anaesthesia. In 11 patients, in whom the end-expiratory CO2 concentration and evoked mechanical response were recorded, increasing curarization caused first a slow CO2 accumulation and later an abrupt ventilatory impairment at a twitch tension of between 5 and 50% of original muscle strength. In 12 patients, in whom the evoked integrated hypothenar EMG, spontaneous frontal EMG and mean frequency and amplitude of the EEG were recorded, the spontaneous frontal EMG and ventilation diminished within 3 min, following the first 5 mg dose of tubocurarine. At this stage muscle strength, indicated by the amplitude of the evoked EMG and the train-of-four ratio, was unchanged. Repeated 5 mg doses of tubocurarine caused an almost linear decrease in ventilation and an increase in end-tidal CO2 concentration without affecting the rate of breathing until the sudden impairment of ventilation that occurred usually after the fourth dose of tubocurarine. The EEG changes during curarization were minimal and no common trend was seen. The results suggest that tubocurarine may be given to anaesthetized patients in a dose which is too small to produce, using the evoked EMG, a detectable neuromuscular block, but is sufficient to cause ventilatory depression without a compensatory increase in the rate of breathing.