Veterinary Anaesthesia and Analgesia, 2009, 36, 246–254
RESEARCH PAPER
The post-tetanic count during vecuronium-induced
neuromuscular blockade in halothane-anaesthetized dogs
Farshid Sarrafzadeh-Rezaei* DVM, DVSc & R Eddie Clutton  BVSc, MRCVS, DVA, Diplomate ECVAA, MRCA
*Department of Clinical Sciences, College of Veterinary Medicine, University of Urmia, Urmia, Western Azerbaijan, IRAN
 Department of Veterinary Clinical Sciences, Royal (Dick) School of Veterinary Studies, Easter Bush, Roslin, Midlothian, UK
Correspondence: R Eddie Clutton, Department of Veterinary Clinical Sciences, Royal (Dick) School of Veterinary Studies, Easter Bush, Roslin,
Midlothian, EH25 9RG, UK. E-mail: e.clutton@ed.ac.uk
Abstract
Objective To evaluate the post-tetanic count (PTC)
for predicting the return of reversible neuromus-
cular blockade at the n. facialis–m. nasolabialis
(nF–mNL) and n. ulnaris–mm. carpi flexorii (nU–
mCF) nerve-muscle units (NMUs) during profound
vecuronium neuromuscular blockade in halothane-
anaesthetized dogs.
Study design Randomized, prospective, experimen-
tal study.
Animals Twenty-five dogs (seven male 18 female)
undergoing surgery; mean age: 4.8 years; mean
body weight 22 kg.
Methods Thirty minutes after acepromazine (0.05
mg kg)1) and morphine (0.5 mg kg)1) pre-medica-
tion, anaesthesia was induced with intravenous (IV)
thiopental and maintained with halothane, N2O and
O2. The lungs were mechanically ventilated and end-
tidal halothane concentration (FE¢HAL) maintained at
1.04%. Neuromuscular transmission was monitored
using the train-of-four count (TOFC) at one nF–mNL
and both nU–mCF units. Vecuronium (50 lg kg)1
IV) was injected after 15 minutes constant FE¢HAL.
When the first twitch (T1) at both nU–mCF units had
disappeared (t = 0) one (randomly allocated) ulnar
nerve was stimulated every 5 minutes using PTC;
TOF stimulation continued at the other sites. The
PTC was plotted against the interval between
246
doi:10.1111/j.1467-2995.2009.00457.
recording time and T1’s reappearance at the other
NMUs.
Results At t = 0, the mean PTC in the contralateral
nU–mCF unit was 18 (range 0–20). Mean PTC was
a minimum at t = 5, rising to the maximum (20) at
25 minutes. Six dogs were vecuronium-resistant as
monitored by PTC. Excluding data from these
revealed a strong negative relationship between
ulnar PTC and the time taken for T1’s return at the
facial (r = )0.7018; p < 0.00001) and contra-
lateral ulnar (r = )0.8409; p < 0.00001) NMUs.
Conclusion and clinical relevance Post-tetanic count
monitoring beginning >5 minutes after the TOFC at
nU–mCF = 0 provided a reliable estimate of T1’s
return at ulnar and facial NMUs.
Keywords dogs, halothane, post-tetanic count, vec-
uronium.
Introduction
During profound neuromuscular blockade, supra-
maximal nerve stimulation using the train-of-four
(TOF) or single twitch stimulation patterns fails to
evoke muscular contraction and complicates the
monitoring of neuromuscular transmission. How-
ever, tetanic stimulation augmented acetylcho-
line release for approximately 90–120 seconds in
response to low-frequency stimulation (Bowman
et al. 1984) and so ‘twitches’ may be detected in
 Post-tetanic count in dogs F Sarrafzadeh-Rezaei and RE Clutton
profoundly relaxed subjects – albeit for a short
period – after tetanic nerve stimulation. Viby-Mog-
ensen et al. (1981) capitalized on post-tetanic
facilitation to develop the post-tetanic count (PTC) –
a stimulation pattern for monitoring intense
neuromuscular blockade. The pattern consisted of
5 seconds of 50 Hz tetanic stimulation, a 3-second
interval, and then single-twitch stimulation at 1 Hz
applied until no further measurable responses were
present. The number of post-tetanic responses
(twitches) may be counted by palpation or force
displacement transduction (Howardy-Hansen et al.
1984). Simultaneously measuring TOF responses in
one limb and the PTC in the other, Viby-Mogensen
et al. (1981) reported a correlation between the
PTC and the time until spontaneous recovery of
TOF. Consequently, PTC not only quantifies the
depth of intense neuromuscular blockade, but can
be used to predict the time elapsing before reversible
block, i.e., when the first twitch in TOF (Caldwell
et al. 1986; Engbaek et al. 1990) is present.
The PTC has not been evaluated in dogs. This is
unfortunate because profound neuromuscular block-
ade is desirable in operative procedures where sudden
unexpected movement may be catastrophic, e.g.
spinal, intracranial or intra-ocular surgery, or where
the operation involves nerve-muscle units (NMUs)
resistant to neuromuscular blocking agents. Marked
variation in individual sensitivity to muscle relaxants
also ensures profound relaxation occurs in a pro-
portion of animals given normal or even low doses.
This is more likely when neuromuscular trans-
mission is monitored in sensitive NMUs. Hall et al.
(2001) considered the n. ulnaris–mm. carpi flexorii
(nU–mCF); unit to be most useful for monitoring
neuromuscular blockade in dogs, in part because
Cullen et al. (1980) failed to establish normal facial
muscle responses in dogs. Recent study indicated the
reliability of facial mechanomyography in dogs and
revealed the relative sensitivity of the n. facialis–m.
nasolabialis (nF–mNL) unit to vecuronium compared
with m. ulnaris–mm. carpi flexorii (Sarrafzadeh-Rezaei
& Clutton 2009). The objective of the current study
was to evaluate the PTC for predicting the return of
reversible vecuronium-induced blockade at the
nU–mCF and at m. facialis–m. nasolabialis units in
halothane-anaesthetized dogs.
Materials and methods
Neuromuscular blockade was produced with vecu-
ronium (50 lg kg)1) in 25 dogs of various breeds
 2009 The Authors. Journal compilation  2009 Association of Veterinary Anaesthetists, 36, 246–254
and either gender presented at the Hospital for
Small Animals, University of Edinburgh over a
6-month period for surgery in which neuromusc-
ular blockade was used as part of the anaesthetic
technique.
The mean [±standard deviation (SD); range] age of
animals studied was 4.8 ± 3.1 (0.5–10) years and
mean body mass was 22 ± 7.8 (10–39) kg. Five
entire males, two castrated males, eight entire
females and 10 neutered females were studied. Other
characteristics are detailed in Table 1. Animals not
in full health (based on medical history, physical,
haematological and biochemical examination),
extremes of age (<6 months and >10 years), the
extremely lean or obese and those receiving medica-
tion known to affect neuromuscular transmission
were excluded from study. The project was approved
by the Institutional Ethical Review Committee.
Food was withheld overnight and water removed
1 hour before pre-anaesthetic medication, which
was acepromazine (ACP, C-Vet; Grampian Pharma-
ceutical Ltd, Lancashire, UK) 0.05 mg kg)1 mixed
in the same syringe with morphine (Celltech Phar-
maceuticals Limited, Berkshire, UK) 0.5 mg kg)1
and administered by intramuscular injection into
the lumbar epaxial muscles 30 minutes before
induction of anaesthesia. A cannula was placed in
the cephalic vein and an injection cap connected.
General anaesthesia was induced with intravenous
(IV) 2.5% thiopental given to effect. The trachea
was intubated with a cuffed endotracheal tube and
anaesthesia maintained with halothane delivered
from a calibrated vaporizer (Fluotec vaporizer;
Cyprane, Keighley, UK) and carried in an O2:N2O
(1:2) mixture via an appropriate anaesthetic breath-
ing system (Mapleson A, D, F or circle). Ringer’s
lactate solution was infused at 10 mL kg)1 hour)1.
For approximately 15 minutes after induction dogs
breathed spontaneously, but intermittent positive
pressure ventilation was later imposed using a
mechanical ventilator (Manley Pulmovent, Model
MPP; BOC Medishield, London UK). A paediatric
flow restrictor was used in animals weighing
<12 kg (Tunstall 1973). Before surgery began, gas
flows were set at 200 mL kg)1 minute)1, but these
were later adjusted to maintain end-tidal carbon
dioxide tensions (PE¢CO2) between 5.0 and 5.8 kPa
(38–44 mmHg) (Millennia Model 3500, Vital Signs
Monitoring System; In Vivo Research Inc, Orlando,
FL, USA). The vaporizer settings were adjusted to
maintain FE¢HAL concentrations at 1.2· published
MAC values (Eger et al. 1965) i.e., 1.04%.
247
Post-tetanic count in dogs F Sarrafzadeh-Rezaei and RE Clutton

Table 1 Characteristics of 25 dogs

‘Nonresistant’ ‘Resistant’ receiving vecuronium whilst anaes-
(n = 19) (n = 6) thetized with halothane. Animals
were divided into ‘nonresistant’ and
Age (years) 4.6 ± 3.0 5.7 ± 3.8 ‘resistant’ groups based on responses
(0.5–10.0) (2–10) to the post-tetanic count (PTC)
Body mass (kg) 24.8 ± 7.3* 15.2 ± 4.0*
(12.0–38.5) (10.0–23.0)
Gender
Male 5 0
Neutered M 2 0
Female 4 4
Neutered F 8 2
Breeds
Labrador retriever 1 Border collie 1
Golden retriever 1 Cavalier King Charles 1
Spaniel
Labrador cross 3 Collie 1
Springer spaniel 2 Jack Russell Terrier 1
Cross bred 2 Lurcher 1
Airedale terrier 2 Staffordshire Bull terrier 1
English Bull terrier 2
German Shepherd 1
Rough collie 1
Rottweiler 1
Standard poodle 1
Vizsla 1
Yorkshire terrier cross 1
Operations
CCL repair 5 Ovariohysterectomy and 1
umbilical herniorrhaphy
Ovariohysterectomy 4
Exploratory laparotomy 3
Femoral fracture fixation 1
Ectopic ureter 1 Ovariohysterectomy and 1
mammary gland tumour
Castration 1
Femoral fracture fixation 1
Urinary bladder biopsy 1
Colposuspension 1 Ovariohysterectomy 1
Total hip replacement 1 CCL repair 1
Anal sacculectomy 1
Patella luxation 1

Data presented as mean ± standard deviation; [range]. The mean body masses between
groups were significantly (p < 0.005)* different. CCL, cranial cruciate ligament.

Neuromuscular blockade was monitored initially
using the TOF stimulation pattern applied every
12 seconds (83.3 mHz) to both n. facialis and the
left and right ulnar nerves. Three programmed
peripheral nerve stimulators were used: Bard stim-
ulators (Bard Biomedical, Buffalo, NY, USA) on the
facial, and on one ulnar nerve, while a Microstim
DB (Microstim DB; Viamed, Keighley, West York-
shire, UK) was used on the other n. ulnaris. All
devices delivered four supramaximal (>60 mA)
stimuli each of 0.3 ms duration applied at 2 Hz
using transcutaneous stainless steel electrodes
passed over each nerve. The Microstim DB, which
was used to deliver the PTC, delivered 20 impulses
at 1 Hz after 5 seconds of tetanic (50 Hz) stimula-
tion and a 3 second interval. The ulnar nerve was
stimulated on the medial surface of the humero-
radial joint at the level of the olecranon. The dorsal
buccal branch of the facial nerve was stimulated
using two electrodes 0.5–1.0 cm apart at the fourth
upper premolar tooth. Electrode position was
adjusted to ensure maximum responses. In all cases,

248  2009 The Authors. Journal compilation  2009 Association of Veterinary Anaesthetists, 36, 246–254
 Post-tetanic count in dogs F Sarrafzadeh-Rezaei and RE Clutton
the cathode was positioned distally. The number
and strength of evoked responses (twitches) in the
carpal flexor muscles were detected by palpation
(Lee & Katz 1980) and by observation to determine
the train-of-four count (TOFC). Responses in the
nasolabial muscles were detected by palpating the
retraction of the lateral nasal fold. The brachium
and antebrachium of the monitored limbs were
lightly wrapped in ‘bubble wrap’ and aluminium foil
in an attempt to prevent muscle cooling although
neither muscle nor skin temperature were recorded.
Neuromuscular blockade was produced with
vecuronium (Norcuron; Organon Laboratories
Ltd., Cambridge, UK) 50 lg kg)1 injected IV into
the injection port of the venous catheter 50–
60 minutes after inhalation anaesthesia was begun,
after FE¢HAL had been stable for at least 15 minutes
and after 15 trains had been delivered. Injection
was completed in <1 second during, which fluids
were infused at the greatest rate possible under
gravity. The time to disappearance of T4 (latent
onset) and T1 (manifest onset) at both facial and
ulnar sites were recorded. Once profound block
(TOFC = 0) was present in both nU–mCF units
(t = 0) the nerve stimulation pattern was changed
to PTC in one (randomly assigned) limb and was
monitored at 5 minute intervals thereafter. TOF
stimulation was continued at 83.3 mHz in the
contralateral limb and the nF–mNL unit until the
TOFC was 4 in both. Animals were defined as being
resistant to the vecuronium if the PTC either never
achieved a zero value, or returned to ‡15 within
5 minutes of having done so, despite having a
complete loss of the TOFC.
Vital signs were monitored throughout anaesthe-
sia, the heart and lung sounds were auscultated
with an oesophageal stethoscope and the electro-
cardiogram was displayed continuously. Oscillo-
tonometry (Dinamap, Critikon, Model 1846SX,
Tampa, FL, USA) was used to monitor arterial blood
pressure with the cuff positioned on the pelvic limb.
All dogs received 0.2 mg kg)1 meloxicam IV (Meta-
cam; Boehringer Ingelheim, Bracknell, Berkshire,
UK) before surgery began. Mean arterial blood
pressure was maintained >60 mmHg by increasing
fluid infusion rate and, or by infusing dobutamine.
A thermistor (Edale GC203 Digital Thermometer,
Longstanton, Cambridge, UK) was positioned in the
oesophagus at heart level and the temperature
maintained at approximately 37 C [98.6 F] using
a heated table, insulation and a high ambient
temperature. The dogs were allowed to recover
 2009 The Authors. Journal compilation  2009 Association of Veterinary Anaesthetists, 36, 246–254
spontaneously from neuromuscular blockade.
Mechanical lung ventilation was discontinued once
all four twitches had returned at the nF–mNL unit,
although periodic lung inflation was imposed until
spontaneous breathing was judged to be adequate
on the basis of: a eupnoeic breathing pattern with
normal respiratory rate; pink mucous membranes;
SPO2 values >90% PE¢CO2 values between 5.3 and
6.0 kPa (40 and 45 mmHg).
Statistics
The PTC at each recording was plotted against the
interval (in minutes) between the time at recording
and the reappearance of T1 at the other nU–mCF
and the nF–uNL unit. An exponential regression
line was tested (STATISTICA version 6; StatSoft, Ltd,
Bedford, UK) on the assumption that drug washout
from the neuromuscular junction followed a nega-
tive exponential curve. The Mann–Whitney U-test
was used to compare differences between age, body
mass, the onset of blockade and the return of T1 at
the face and ulnar nerve in two, subsequently
identified groups of subjects. Yates chi-square test
was used to compare the gender distribution
between these groups. Data are expressed as
mean ± SD. A p value £0.05 was considered to
indicate statistical significance.
Results
On the basis of their response to PTC stimulation six
dogs appeared to be relatively resistant to vecuro-
nium. These were not distinguishable from non-
resistant dogs in terms of age, gender distribution,
breed or operation although they had a significantly
lower (p < 0.005) body mass than nonresistant
animals (Table 1).
After vecuronium injection, the latent and man-
ifest onset times at the nF–mNL unit, were
76 ± 17 seconds (48–120) and 94 ± 21 (48–132)
seconds respectively. Corresponding values at the
nU–mCF unit were 97 ± 21 seconds (48–144) and
118 ± 24 (48–168) seconds. The facial unit was
more sensitive to vecuronium than the nU–mCF
group at the onset of blockade: in 21 dogs, the facial
T1 disappeared 31 ± 19 (12–72) seconds before T1
at the nU–mCF unit, while in four dogs, T1
disappeared at both the facial and ulnar units
within 12 seconds of each other.
The loss of T1 at one nU–mCF unit (when t = 0)
corresponded to a range of values for the PTC in the
249
Post-tetanic count in dogs F Sarrafzadeh-Rezaei and RE Clutton

contralateral unit: in 20 dogs at this time, PTC was
20, two had PTCs of 19, in one animal it was 17 and
in the remaining two there were no evoked
responses detected. In all dogs, PTCs were a minima
at t = 5 minutes, but increased after this so that the
maximum possible value of 20 was counted in 19
dogs at t = 20 and was present in all 25 dogs when
t = 25 minutes (Fig. 1). There was considerable
variation in the PTC count at each recording
interval. Whilst T1 at the nU–mCF unit was elim-
inated in all cases, PTC monitoring revealed that six
dogs were relatively resistant to vecuronium. In
these, the PTC either never achieved a zero value,
(n = 4) or was restored to a high value (15 or more)
within 5 minutes of having done so (Fig. 1). There
were no differences in latent and manifest onset
times at both NMUs in the six dogs proving PTC-
resistant, and those that were not (Table 2). How-
ever, the time T1 returned to the nU–mCF unit was
significantly (p < 0.02) briefer in resistant animals.
Plotting all data points revealed a weak inverse
relationship between PTC and the interval between
recording time and T1’s reappearance at the contra-
lateral nU–mCF unit and the facial muscle. Wide
variation resulted from the high number of cases in
which PTC = 20 at t = 0 and data from the six
‘resistant’ animals. However, when data from these
and the t = 0 recording interval were excluded, the
x-y plots congregated along an exponential regres-
sion line for both ulnar (Fig. 2a) and facial units
(Fig. 2b). The gradient of the regression line in Fig. 2a
links PTC with time T1 returns and is given by: time
(minutes) to nU–mCF T1 = 11.945)0.0918 · PTC;
(r = )0.8409; p < 0.00001). An exponential line

Figure 1 Dot diagram showing the

post-tetanic count taken at 5 minute
intervals at the n. ulnaris–mm. carpi
flexorii unit after the train-of-four
count = 0 at the contralateral nerve-
muscle unit in 19 ‘normal’ (s) and
six vecuronium-resistant dogs ( ) •
anaesthetized with halothane. The
resistant cases showing a PTC of 0
at 5 and 10 minutes are different
animals.

Table 2 Responses of the n. facialis–m. nasolabialis and the n. ulnaris–mm. carpi flexorii nerve-muscle units to train-of-four
nerve stimulation in 25 halothane-anaesthetized dogs after vecuronium (50 lg kg)1). Animals were divided into
‘nonresistant’ and ‘resistant’ groups based on post-tetanic counts after vecuronium

Nerve-muscle unit ‘Nonresistant’ (n = 19) ‘Resistant’ (n = 6)

Latent onset (seconds) n. facialis–m. nasolabialis 77 ± 19 (48–120) 72 ± 8 (60–84)

n. ulnaris–mm. carpi flexorii 97 ± 22 (48–132) 98 ± 9 (84–108)
Manifest onset (seconds) n. facialis–m. nasolabialis 92 ± 22 (48–132) 98 ± 16 (72–120)
n. ulnaris–mm. carpi flexorii 116 ± 27 (48–168) 124 ± 10 (108–132)
T1 returns (minutes) n. s–m. nasolabialis 29.6 ± 10.2 (16.2–46.1) 26.8 ± 5.7 (16.2–32.6)
n. ulnaris–mm. carpi flexorii 18.5 ± 5.7* (10.4–25.6) 14.0 ± 3.3* (10.4–19.8)

Data are presented as mean ± standard deviation; [range]. There were no differences in latent and manifest onset times at either site in
the six PTC-resistant dogs. A Mann–Whitney U-test indicated T1 returned at n. ulnaris–mm. carpi flexorii unit significantly (p < 0.02)*
more rapidly in resistant animals.

250  2009 The Authors. Journal compilation  2009 Association of Veterinary Anaesthetists, 36, 246–254
 Post-tetanic count in dogs F Sarrafzadeh-Rezaei and RE Clutton

(a)

(b)

Figure 2 The regression lines linking post-tetanic count (PTC) in the n. ulnaris–mm. carpi flexorii unit with the time (in
minutes) T1 returned at (a) the contralateral unit and at (b) the n. facialis–m. nasolabialis unit are described by the
expressions T1 return (minutes) at (a) 11.945)0.0918 · PTC (r = )0.8409; p < 0.00001) and at (b) 24.2498)0.044 · PTC
(r = )0.7018; p < 0.00001). In (a) negative values for T1 reappearance indicate that T1 returned before the
corresponding PTC.

also provided the best fit between PTC with T1 Comparing these equations to predict T1’s return at
return at nF–mNL (Fig. 2b) with the relationship the facial and ulnar units confirmed the suggestion
expressed as time (minutes) to T1 at nF–mNL = that the nasolabial muscles are more sensitive to
24.2498)0.044 · PTC; (r = )0.7018; p < 0.00001). vecuronium than the carpal flexor muscles. When

 2009 The Authors. Journal compilation  2009 Association of Veterinary Anaesthetists, 36, 246–254 251
Post-tetanic count in dogs F Sarrafzadeh-Rezaei and RE Clutton
PTC was 10, the predicted time of T1’s reappearance
at the nU–mCF unit was 5 minutes, compared with
16 minutes at the nF-mNL. In most dogs, there was a
strong negative relationship between the ulnar PTC
and the time taken for T1 to return at the facial and
contralateral ulnar NMU, providing readings were
not made within 5 minutes of T1 disappearance at
the contralateral nU–mCF.
Discussion
The presence of a PTC when the TOFC was 0 indi-
cated that post-tetanic facilitation occurred at the
motor nerve terminals of n. ulnaris in canine, as well
as human subjects and that the PTC was a useful
indicator of profound neuromuscular blockade in
this species. Furthermore, the PTC at the nU–mCF
usefully predicted the time when reversible blockade
became established at the contralateral nU–mCF
and the nF–mNL during recovery from profound
vecuronium-induced neuromuscular blockade. In
medical studies, the relationship between time to T1
reappearance and the PTC has been established for
vecuronium, atracurium and rocuronium (Bonsu
et al. 1987; Muchhal et al. 1987; Schultz et al.
2001) and has been described in terms of a non-
linear decrease with the square root of PTC (El-Orbany
et al. 2003). The slope of the predicted mean curves
in the current study (Figs 2a & b) generated when
certain data (vide infra) were excluded were similar to
the regression lines derived for other intermediate-
duration neuromuscular blocking drugs in human
patients (Howardy-Hansen et al. 1984; Bonsu et al.
1987; Muchhal et al. 1987; Schultz et al. 2001).
Differences in the absolute values obtained probably
arose because of different variables, i.e., drugs, doses,
experimental conditions and sensitivity of the human
n. ulnaris–m. adductor pollicis unit compared with the
nU–mCF in dogs.
A PTC of 1 at the nU–mCF provided adequate
indication of T1’s return at both ulnar and facial
units, where the minimum–maximum interval
between these events was 6–15 and 13–31 minutes
respectively. This confirmed the relative sensitivity
of the facial NMUs and indicated that during
ophthalmic surgery, for example, a PTC of 1 at
the nU–mCF would mean that measureable muscle
activity in the face would not return for at least
13 minutes.
The high predictive value of PTC monitoring
established in the current study depended on
excluding data from ‘resistant’ cases, and high
252  2009 The Authors. Journal compilation  2009 Association of Veterinary Anaesthetists, 36, 246–254
PTC values recorded when t = 0. However, this
does not detract from the technique’s clinical
usefulness for two reasons. First, a high PTC
registered within a minute or two of T1’s
disappearance could be readily recognized and
discounted as an indicator of impending recovery
from neuromuscular blockade. Second, ‘resistant’
dogs were readily identified by the persistence
of high PTC values, which in turn should warn of
potential inaccuracies in the test’s ability to predict
T1’s return.
The presence of ‘resistant’ dogs in the current
study was difficult to explain – as is the mechanism
of their resistance. Individual variation in response
to neuromuscular blocking agents is well recognized
in both humans with d-tubocurarine (Katz 1967)
and atracurium (Katz et al. 1982) and in dogs with
atracurium (Jones & Clutton 1984; Hall et al. 1985)
rocuronium (Alderson et al. 2007) and particularly
cis-atracurium (Adams et al. 2001). In other stud-
ies involving dogs, the incidence of notable resis-
tance was considerably <6 of 25. One possible
reason for the greater incidence reported here is the
low dose of vecuronium. However, if under-dosing
alone accounted for the failure to lower PTC values
in resistant animals, then a slower onset and a more
rapid recovery from block would have been
expected. The absence of differences in latent and
manifest onset times at both NMUs between resis-
tant and nonresistant animals might be explained in
terms of a type II error, in which case further study
comparing larger groups of ‘resistant’ with ‘non-
resistant’ dogs is required. The gender distribution
of resistant versus non-resistant animals in this
study was not statistically significant although all
resistant animals were female. This is unexpected
because women are more sensitive to atracurium
(Xue et al. 1999) and rocuronium (Mencke et al.
2000) than men. The same is probably true for
vecuronium. The apparent volume of distribution of
vecuronium in dogs and humans is of the same
order as the extra-cellular fluid volume (Booij et al.
1981). This is lower in women than men of similar
mass, and theoretically renders the former more
sensitive to fixed vecuronium doses. Vecuronium’s
volume of distribution at steady state in women
and men (164.8 ± 29.3 mL kg)1 versus 201.4 ±
75.8 mL kg)1 respectively) is significantly different
(Xue et al. 1998). The mean body mass of resistant
dogs was significantly lower than that of the
nonresistant cases although previous studies have
not indicated that smaller dogs are any more
 Post-tetanic count in dogs F Sarrafzadeh-Rezaei and RE Clutton
resistant to relaxants than large ones (Jones 1985;
Jones & Seymour 1985). Furthermore, excessively
lean and obese animals were excluded from the
current study because obesity altered the human
subject’s response to vecuronium (Schwartz et al.
1992). Smaller animals have elevated metabolic
rates, which may be expected to accelerate a drug’s
disposition and clearance from the body thus
conferring the impression of resistance. On the
other hand, the body temperature of small dogs is
likely to fall more rapidly than in large breeds,
which will increase sensitivity to vecuronium-
induced neuromuscular blockade through impaired
drug clearance and reduced rate of effect site
equilibration (Caldwell et al. 2000). Atypical
responders to PTC stimulation have been identified
in human subjects (El-Orbany et al. 2003).
The value of the PTC to predict the return of
reversible block depends on the relaxant (Viby-
Mogensen et al. 1981) and the anaesthetic agents
(Saitoh et al. 1998; El-Orbany et al. 2003) used. It
also depends on the relaxant dose, at least with
rocuronium (Schultz et al. 2001). An examination
of any of these factors in dogs would provide
avenues for further study. The possibility that low
vecuronium doses increased the dispersal of x-y
plots linking PTC and predicted T1 return time
justifies an examination of higher doses, e.g.
100 lg kg)1, in a larger number of dogs. However,
more fundamental work examining the effects of
breed, body mass and gender in dogs of similar age
on the response to neuromuscular blocking agents
seems overdue.
In a majority of halothane-anaesthetized dogs,
the PTC stimulation pattern applied at the n.ulnaris–
m carpi flexorii unit reliably predicted the return of
reversible vecuronium-induced neuromuscular
blockade at the contralateral NMU and at the
n. facialis–m nasolabialis units providing monitoring
begins >5 minutes after T1 disappears.
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Received 13 February 2008; accepted 8 April 2008.