Optimized Neuromuscular Blockade Reversal Without Train Of Four Monitoring Versus Neuromuscular Blockade Reversal Using Quantitative Train Of Four Monitoring A Comparative Study

Abstract

Postoperative residual neuromuscular blockade is a common finding in anaesthesia practice with newlineincidence ranging from 26% to 88%1 ,2 . Depending on the definitions used, the setting, the newlineneuromuscular blocking agent used, and patient population studied. Train of four (TOF) monitoring is a newlinedevice used to describe the pattern of electrical nerve stimulation and evaluate the degree of newlineneuromuscular blockade. After delivery of four successive stimulating currents to a selected peripheral newlinenerve with the peripheral nerve stimulator, the number of twitches is observed 3 ,4 . Depending on the newlinenumber of twitches the TOF monitoring device calculate the TOF ratio. If the TOF ratio is more than 0.9 it newlineis considered as adequate recovery from neuromuscular blockade newlineAfter the introduction of train of four (TOF) monitoring in 1970, residual neuromuscular blockade was newlinedefined as TOF ratio /=0.9 has been suggested as minimally acceptable level of recovery of neuromuscular newlinefunction. Less residual paralysis was demonstrated when quantitative neuromuscular monitoring was newlineapplied. However, the device is not widely available, only 9.4-22.7% of clinicians had access to quantitative newlineTOF monitoring in their practice . Hence majority of the anesthetist were forced to depend on the clinical newlinesigns and parameters for assessing the depth of anesthesia and for reversal from neuromuscular blockade newlineThe clinical criteria include adequate tidal volume (4- 5ml/kg), sustained head lift for 5sec, breathing newlinespontaneously, obeying commands, intact gag reflex, minimal end expiratory concentration of inhaled newlineanesthetics 9 ,1 0 . But these clinical criteria do not exclude residual paralysis newlineThe aim of the study is to assess whether neuromuscular blockade reversal using clinical parameters is newlineequivalent to neuromuscular blockade reversa l using TOF monitoring for postoperative residual newlineneuromuscular paralysis newline