Monitoring Depth of Neuromuscular Blockade

Purpose of ReviewThis review discusses alternative quantitative neuromuscular blockade monitoring methods and advantages and disadvantages of each when used in clinical practice.Recent FindingsQuantitative neuromuscular blockade monitors are not always validated against gold standard mechanomyography before becoming commercially available. Validation is particularly important for electromyography because of the importance of managing electrical noise and distinguishing electromyographic signal from noise. The use of acceleromyography must take into account that baseline train-of-four ratio frequently exceeds 1.0.SummaryAll commercially available and any new neuromuscular blockade monitors should be validated against mechanomyography. Acceleromyography represents a particular challenge because of frequent baseline train-of-four ratios greater than 1.0.