Monitoring and Antagonism of Neuromuscular Blockade

Basic Principles and Terminology

The following definitions are used For the purposes of this guideline:

Clinical assessment of recovery from neuromuscular blockade: using “clinical” assessments of paralysis, e.g., sustained head lift, grip strength or respiratory measurements.

Double Burst Stimulation (DBS): Two short bursts of tetanic stimuli used to make visual/tactile fade easier to spot when electronic tools are limited.

Normalization of train-of-four ratios to the baseline (control): value obtained before neuromuscular block is accomplished by dividing the postoperative measurements by the baseline value.

Post-Tetanic Count (PTC): Used for intense blocks when TOF shows 0 twitches. A 50 Hz stimulus is given followed by single twitches to gauge how close the patient is to returning to a measurable TOF.

Qualitative assessment: using peripheral nerve stimulators (which could deliver a single stimulus and sometimes a tetanic stimulus).

Quantitative monitoring: amplitude of the twitches can be measured quantitatively to permit the calculation of the train-of-four ratio.

Train-of-Four (TOF): The gold-standard test delivering 4 rapid impulses at 2 Hz. It tracks "fade," measuring the ratio of the 4th twitch amplitude to the 1st (T4:T1).