Anesth Pain Med.  2017 Jan;12(1):1-8. 10.17085/apm.2017.12.1.1.

What anesthesiologists ask to know and should know about the neuromuscular monitoring: an updated review

• Lee S

• KMID: 2369658
• DOI: http://doi.org/10.17085/apm.2017.12.1.1

Abstract

The increase in mortality and morbidity associated with the use of muscle relaxants, is associated with a lack of clinical pharmacological knowledge of the drugs, and a lack of understanding the risk of postoperative residual curarization. This is due to the absence of standards for neuromuscular monitoring. Clinicians experienced in neuromuscular monitoring and using muscle relaxants in the clinic may have some queries regarding the monitoring: Why should neuromuscular monitoring be done? Are clinical tests really not effective? Why is it not good when I actually perform neuromuscular monitoring? Would using sugammadex not require neuromuscular monitoring? This review answers most of the questions that many clinicians have, and also forwards the knowledge required of clinicians.

Keyword

Acceleromyography; Muscle relaxation; Neuromuscular monitoring; Postoperative residual curarization; Sugammadex; Train-of-four

MeSH Terms

Delayed Emergence from Anesthesia
Mortality
Muscle Relaxation
Neuromuscular Monitoring*

Figure

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  Fig. 1 The change over time in the levels of block after administration of intubating dose of non-depolarizing neuromuscular blocking drug (Adapted from Fuchs-Buder T. Sugammadex: clinical development and practical use. Korean J Anesthesiol. 2013; 65: 495-500). NMBA: neuromuscular blocking agent, PTC: post-tetanic counts, TOF: train-of-four.

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  Fig. 2 Supramaximal stimulation. Neuromuscular response increases with increasing current. Here, 30 mA marks the threshold to supramaximal stimulation. Typically, the supramaximal current is deduced by adding 10–20% to the maximum current.

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  Fig. 3 Difference of individual muscle’s sensitivity to neuromuscular blockade drugs, which cause to make a different sensitivity between diaphragm and adductor pollicis muscle. The onset and recovery of muscle relaxation is faster in diaphragm.

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