Train-of-four ratio recovery often precedes twitch recovery when neuromuscular block is reversed by sugammadex

Background: Sugammadex reverses rocuronium-induced neuromuscular block (NMB). In all published studies investigating sugammadex, the primary outcome parameter was a train-of-four (TOF) ratio of 0.9. The recovery time of T1 was not described. This retrospective investigation describes the recovery of T1 vs. TOF ratio after the reversal of NMB with sugammadex. Methods: Two studies were analyzed. In study A, a phase II dose-finding study, ASA I-II patients received an intravenous (IV) dose of rocuronium 1.2 mg/kg, followed by an IV dose of sugammadex (2.0, 4.0, 8.0, 12.0 or 16.0 mg/kg) or placebo (0.9% saline) after 5 min. In study B, a phase III trial comparing patients with renal failure and healthy controls, rocuronium 0.6 mg/kg was used to induce NMB; sugammadex 2.0 mg/kg was administered at reappearance of T2. Neuromuscular monitoring was performed by acceleromyography and TOF nerve stimulation. The primary efficacy variable was time from the administration of sugammadex to recovery of the TOF ratio to 0.9. Retrospectively, the time to recovery of T1 to 90% was calculated. Results: After the reversal of rocuronium-induced NMB with an optimal dose of sugammadex [16 mg/kg (A) or 2 mg/kg (B)], the TOF ratio recovered to 0.9 significantly faster than T1 recovered to 90%. Clinical signs of residual paralysis were not observed. Conclusion: After the reversal of NMB by sugammadex, full recovery of the TOF ratio is possible when T1 is still depressed. The TOF ratio as the only measurement for the adequate reversal of NMB by sugammadex may not always be reliable. Further investigations for clinical implications are needed

Nanoscale holographic interferometry for strain measurements in electronic devices

International audienceStrained silicon is now an integral feature of the latest generation of transistors and electronic devices1,2,3 because of the associated enhancement in carrier mobility4,5. Strain is also expected to have an important role in future devices based on nanowires6 and in optoelectronic components7. Different strategies have been used to engineer strain in devices, leading to complex strain distributions in two and three dimensions8,9. Developing methods of strain measurement at the nanoscale has therefore been an important objective in recent years but has proved elusive in practice1,10: none of the existing techniques combines the necessary spatial resolution, precision and field of view. For example, Raman spectroscopy or X-ray diffraction techniques can map strain at the micrometre scale, whereas transmission electron microscopy allows strain measurement at the nanometre scale but only over small sample areas. Here we present a technique capable of bridging this gap and measuring strain to high precision, with nanometre spatial resolution and for micrometre fields of view11. Our method combines the advantages of moiré techniques12 with the flexibility of off-axis electron holography13 and is also applicable to relatively thick samples, thus reducing the influence of thin-film relaxation effects