We investigate claims about reversal of neuromuscular blockade.

Claim 1. Location of train-of-four assessment matters

Claim 2. Train-of-four is unnecessary with "sufficient" time from the last dose

Claim 3. Fade can be discriminated by tactile assessment

Our guest today is Dr. Daniel Saddawi-Konefka of the Massachusetts General Hospital.

Full show notes available at depthofanesthesia.com.

Connect with us @DepthAnesthesia on Twitter or [email protected].

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Music by Stephen Campbell, MD.

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References

Arain Sr, Kern S, Ficke DJ, Ebert TJ. Variability of duration of action of neuromuscular blocking drugs in elderly patients. Acta Anaesthesiol Scand. 2005;49:312–315.

Caldwell JE. Reversal of residual neuromuscular block with neostigmine at one to four hours after a single intubating dose of vecuronium. Anesth Analg 1995;80:1168 –74

JØRGEN VIBY-MOGENSEN, NIELS HENRIK JENSEN, JENS ENGBAEK, HELLE ØRDING, LENE THEIL SKOVGAARD, BENT CHRAEMMER-JØRGENSEN; Tactile and Visual Evaluation of the Response to Train-of-four Nerve Stimulation. Anesthesiology1985;63(4):440-442.

Stephan R. Thilen, Bradley E. Hansen, Ramesh Ramaiah, Christopher D. Kent, Miriam M. Treggiari, Sanjay M. Bhananker; Intraoperative Neuromuscular Monitoring Site and Residual Paralysis. Anesthesiology 2012;117(5):964-972. doi: 10.1097/ALN.0b013e31826f8fdd.

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