Quantitative Neuromuscular Monitoring

CA-2 · I.A.2.h II.A.1.a II.A.1.b.3

32Sources
6Kept
1Dropped

1 · Find evidence

PubMed query

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32 candidate papers

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PubMed query

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2 · Teaching points

Source

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7 points

Use quantitative monitoring (train-of-four ratio) to guide reversal decisions, aiming for a train-of-four ratio ≥0.9 before extubation in patients not undergoing cardiac surgery. PMID 36520073 — not confirmed against the abstract: The abstract discusses guidelines for managing neuromuscular monitoring and antagonism but does not specify the use of quantitative monitoring (train-of-four ratio), specific reversal targets (≥0.9), or exclude cardiac surgery patients. dropped
Where quantitative monitoring and sugammadex are readily available, residual block in recovery fell to 2.2%, against published incidences ranging from 3.5% to 53.3% since 2000. PMID 39443187 kept
Randomising to acceleromyography rather than qualitative train-of-four cut residual blockade in recovery from 30% to 4.5%, and no acceleromyography patient desaturated below 90% or obstructed during transport. PMID 18719436 kept
Despite qualitative monitoring and neostigmine, 63.5% of patients still had a train-of-four ratio under 0.9 at extubation — clinical judgement plus a nerve stimulator does not detect residual block. PMID 25902322 kept
Absence of fade on a peripheral nerve stimulator does not exclude residual block — train-of-four ratios as low as 0.4 to 0.6 can be present when no fade is visible. PMID 28795964 kept
Whenever a neuromuscular blocker is given, monitor at the hand with a quantitative device: documenting a train-of-four ratio of at least 0.90 is the only way to confirm satisfactory recovery, and the 5-second head lift should be abandoned. PMID 29200077 kept
Acceleromyography reduced residual block from 50% to 14.5% and left patients with fewer symptoms of weakness, even though visible signs of weakness were rare in both groups. PMID 21946094 kept

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