Questions · Quantitative Neuromuscular Monitoring
10 questions, 0 approved. Approve them one at a time — a quiz shows nothing you have not.
Recall — derived from a kept point
State the core recommendations of the 2018 consensus statement on perioperative use of neuromuscular monitoring: when monitoring is indicated, where on the body and with what type of device, the numeric endpoint that confirms satisfactory recovery, and which traditional bedside test the statement says to abandon.
Answer: 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.
The consensus is unambiguous: any neuromuscular blocker means a quantitative device at the hand and a documented train-of-four ratio of at least 0.90, and the 5-second head lift is no longer acceptable as proof.
Source claim: 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.
Consensus Statement on Perioperative Use of Neuromuscular Monitoring, Anesthesia and analgesia 2018
recall · CA-1 · phrased by llm
A resident sees no fade in the train-of-four response on a peripheral nerve stimulator and concludes that residual neuromuscular block has been excluded. State what range of train-of-four ratios can be present when no fade is visible, and say whether the resident's conclusion holds.
Answer: The conclusion does not hold: absence of fade on a peripheral nerve stimulator does not exclude residual block, because train-of-four ratios as low as 0.4 to 0.6 can be present when no fade is visible.
Your eye saturates well before the neuromuscular junction recovers, so a ratio anywhere from 0.4 to 0.6 can hide behind a train-of-four that looks fade-free.
Source claim: 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.
Neuromuscular Monitoring in the Perioperative Period, Anesthesia and analgesia 2018
recall · CA-2 · phrased by llm
In the RECITE study, patients were managed with qualitative neuromuscular monitoring and neostigmine reversal. State the proportion who still had a train-of-four ratio under 0.9 at extubation, and what the study establishes about clinical judgement combined with a nerve stimulator.
Answer: Despite qualitative monitoring and neostigmine, 63.5% of patients still had a train-of-four ratio under 0.9 at extubation, which shows that clinical judgement plus a nerve stimulator does not detect residual block.
Nearly two thirds of RECITE patients reached extubation with a train-of-four ratio under 0.9, which is why judgement plus a qualitative stimulator cannot be your detection strategy.
Source claim: 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.
The RECITE Study: A Canadian Prospective, Multicenter Study of the Incidence and Severity of Residual Neuromuscular Blockade, Anesthesia and analgesia 2015
recall · CA-2 · phrased by llm
A single-centre prospective observational study, published alongside a systematic review, found residual neuromuscular block in the recovery unit in 2.2% of patients in a setting where quantitative monitoring and sugammadex were readily available, against published incidences ranging from 3.5% to 53.3% since 2000. State what this comparison does and does not establish.
Answer: It establishes that in a setting where quantitative monitoring and sugammadex were readily available the observed incidence of residual block in recovery was 2.2%, at or below the bottom of the 3.5% to 53.3% range published since 2000. It does not establish that those two practices caused the low rate: the comparator is a wide range of incidences from other studies over 25 years rather than a concurrent randomized control group.
This is an observed incidence in one setting benchmarked against a very wide historical range, so treat it as consistent with the practice, not as proof that the monitor and sugammadex produced the number.
Source claim: 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.
Residual Neuromuscular Block in the Postanaesthesia Care Unit: A Single-Centre Prospective Observational Study and Systematic Review, British journal of anaesthesia 2025
recall · CA-3 · phrased by llm
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 ___% or obstructed during transport.
Answer: 90
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.
Intraoperative Acceleromyographic Monitoring Reduces the Risk of Residual Neuromuscular Blockade and Adverse Respiratory Events in the Postanesthesia Care Unit · PMID 18719436
recall · CA-2 · phrased by derived
Acceleromyography reduced residual block from ___% to 14.5% and left patients with fewer symptoms of weakness, even though visible signs of weakness were rare in both groups.
Answer: 50
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.
Intraoperative Acceleromyography Monitoring Reduces Symptoms of Muscle Weakness and Improves Quality of Recovery in the Early Postoperative Period · PMID 21946094
recall · CA-2 · phrased by derived
The point with one number taken out. No model wrote any of this: the stem is the sentence you reviewed, minus a digit, and the paper it came from is named beneath it.
Open prompts
How does your plan change if the patient is not optimised?
open · CA-2 · phrased by derived
What is the physiology behind what we just did?
open · CA-2 · phrased by derived
Talk me through the trade-off you made there.
open · CA-2 · phrased by derived
What would make you abandon this plan and do something else?
open · CA-2 · phrased by derived
Questions only — nothing here asserts anything, which is why a model is allowed to phrase them. Where no model was reachable these are the level defaults.