The Implementation of Quantitative Electromyographic Neuromuscular Monitoring in an Academic Anesthesia Department

Abstract

Implementation of universal electromyographic-based quantitative neuromuscular blockade monitoring required a sustained process of education along with repeated PACU surveys and feedback to providers. Nevertheless, this effort resulted in a significant reduction in the incidence of incompletely reversed patients in the PACU.

Neuromuscular Block and Blocking Agents in 2018

“…Especially at the institutions objective neuromuscular measurement devices should be integrated in the operating room monitoring system. Continuous education of the clinicians in correct use of neuromuscular monitoring and the interpretation of the results is eminently important (40). Tools like dosing charts and algorithms might pull down obstacles.…”

“…The current recommendation for sufficient recovery of NMB is a TOFR ≥0.9 measured at the adductor pollicis muscle (44). Objective monitoring has been shown to reduce residual paralysis and POPCs (8,40).…”

A Twitch in Time

“…Todd et al, 1 writing in this issue of Anesthesia & Analgesia, present another chapter in this illustrious history. Yet, as anesthesiologists we are conflicted every day by the concept of "first, do no harm."…”

“…The literature suggests strongly that the risk of complications and patient discomfort from residual neuromuscular blockade increase sharply if the measured train-of-four ratio (TOF ratio) is <0.9, 3-5 so the first step in the investigation by Todd et al 1 was to use their quantitative monitoring system in patients who newly arrived to the PACU. In other words, the focus was not on the use of nerve stimulators but on residual blockade in the PACU.…”

“…The story told by Todd et al 1 suggests that neuromuscular monitoring might be implemented as department policy, and strong leadership is likely to influence not only practice but outcome as well. The story told by Todd et al 1 suggests that neuromuscular monitoring might be implemented as department policy, and strong leadership is likely to influence not only practice but outcome as well.…”