2020
DOI: 10.1016/j.bja.2019.08.023
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Use of a train-of-four ratio of 0.95 versus 0.9 for tracheal extubation: an exploratory analysis of POPULAR data

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Cited by 87 publications
(70 citation statements)
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References 34 publications
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“…In fact, a post-hoc analysis of the POPULAR study has put forward a 7.8% point adjusted risk reduction in postoperative pulmonary complications associated with the raising of the TOFR cut-off for extubation from 0.9 to 0.95. 60,87,88 This recognition of the importance of full neuromuscular recovery is similarly seen in publications using unity as the recovery cut-off. 10,50 Owing to the paucity of studies using these more restrictive TOFR values, a pooled analysis in the light of these raised cut-offs was not possible.…”
Section: Discussionmentioning
confidence: 70%
“…In fact, a post-hoc analysis of the POPULAR study has put forward a 7.8% point adjusted risk reduction in postoperative pulmonary complications associated with the raising of the TOFR cut-off for extubation from 0.9 to 0.95. 60,87,88 This recognition of the importance of full neuromuscular recovery is similarly seen in publications using unity as the recovery cut-off. 10,50 Owing to the paucity of studies using these more restrictive TOFR values, a pooled analysis in the light of these raised cut-offs was not possible.…”
Section: Discussionmentioning
confidence: 70%
“…33e36 Whilst an nTOFR of <0.9 is understood to be a reasonably sensitive threshold for residual weakness, a recent study suggests that a higher nTOFR of 0.95 can reduce postoperative pulmonary complications. 37 A known occurrence in acceleromyography, baseline TOFR values were often greater than 1.0. 38 Given this significant variability in baseline TOFR values, our study supports the use of nTOFR when possible.…”
Section: Discussionmentioning
confidence: 99%
“…Nevertheless, the principle of "do no harm" would direct dosing information on the side of administering the lowest effective dose. For the NMB reversal agent sugammadex, however, under-dosing presents potential safety concerns for patients, such as inadequate reversal, recurrence of block, and actually an increased risk of postoperative pulmonary complications [20]. Recurrence of NMB occurred in no ABW-dosed patient, but in one patient in the 2 mg/kg IBW group and in one patient of the neostigmine group.…”
Section: Discussionmentioning
confidence: 99%