Monitoring and Antagonism of Neuromuscular Blockade

· Acceptance and implementation of routine quantitative monitoring for patients receiving NMB agents represents a change in clinical practice.

· Strategies for implementation of routine quantitative monitors are infrequently available, and peripheral nerve stimulators used in anesthetics when patients receive NMBs is limited.

· Many clinicians continue to use clinical indicators such as sustained head lift to guide their decision on when to extubate patients. There is no clinical test that is predictive of adequate NM recovery and clinical tests are not applicable when the patient is still under anesthesia.

·  Increasing opportunities to accelerate adoption of quantitative monitoring and improve patient outcomes in the operating room. The clinician needs reliable information as to the patient’s NM function before emergence from anesthesia.

·  There have been multiple calls to follow guidelines to monitor depth of NMB because of the benefits of complete recovery including increased patient satisfaction, decreased length of PACU stay, decreased postoperative pulmonary complications, and decreased mortality.

·  Placing monitors in all anesthetizing locations and involving the department end users in the equipment purchasing decision of the more recent broader range of commercially available equipment choices.

·  Educational efforts for the trainee anesthesia clinicians of the importance and benefits of routine quantitative monitoring; utilizing different mediums equipment, instructional videos, alerts built into the electronic medical record for real-time reminders to record train-of-four ratios and performance feedback.