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Continuing Education in Anaesthesia, Critical Care & Pain 2006 6(1):7-12; doi:10.1093/bjaceaccp/mki067
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Continuing Education in Anaesthesia, Critical Care & Pain | Volume 6 Number 1 2006 © The Board of Management and Trustees of the British Journal of Anaesthesia [2006]. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Monitoring of neuromuscular block

Conor D McGrath, BSc(Hons) MB ChB FRCA, Honorary Lecturer
University Department of Anaesthesia, University Clinical Department, Duncan Building, Daulby Street, Liverpool L69 3GA

Jennifer M Hunter, MB ChB PHD FRCA, Professor of Anaesthesia
University Department of Anaesthesia, University Clinical Department, Duncan Building, Daulby Street, Liverpool, L69 3GA
Tel: 0151 706 4008 Fax: 0151 706 5884 E-mail: jennie@liv.ac.uk (for correspondence)

The first 150 words of the full text of this article appear below.


Key points

Postoperative residual curarization occurs even after administration of intermediate-acting non-depolarizing neuromuscular blocking drugs, for example, atracurium or vecuronium.

Satisfactory recovery from neuromuscular block has not occured until the train-of-four ratio is >0.9.

Quantitative methods of measuring evoked responses, for the example, acceleromyography or mechanomyography, are necessary to ensure adequate recovery from block.

Onset and recovery from neuromuscular block occurs at different rates in different muscles.

Anticholinesterases should not be used to antagonize residual neuromuscular block unless full recovery has been demonstrated.

 

There is increasing evidence that residual neuromuscular block is common, and also that it may adversely affect patient outcome. A study by Debaene and colleagues1 found that 45% of patients had residual curarization (train-of-four [TOF] ratio<0.9) in the postoperative recovery room after a single intubating dose of the intermediate-acting drugs atracurium, vecuronium or rocuronium. Another study found residual curarization (TOF ratio<0.7) in 42% of patients in the . . . [Full Text of this Article]


   Monitoring neuromuscular function
 

   Stimulating the motor nerve
 

   Ideal nerve stimulator
 

   Pattern of nerve stimulation
 
Single twitch stimulation

Train-of-four stimulation

Tetanic stimulation

Post-tetanic count

Double-burst stimulation


   Measuring evoked muscle responses
 
Mechanomyography

Electromyography

Acceleromyography


   Which nerve to stimulate and when?
 
Induction of anaesthesia

Maintenance of anaesthesia

Reversal and recovery


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