Residual neuromuscular block cannot be excluded by clinical signs or by feeling for fade. Quantitative monitoring is the only reliable way to confirm adequate recovery.
Before extubation after a non-depolarising relaxant, confirm a measured train-of-four ratio of 0.9 or more. If the ratio is lower, give or top up reversal and wait.
- Use a quantitative monitor whenever a non-depolarising relaxant is given.
- Confirm a train-of-four ratio of 0.9 or more before extubation.
- Do not rely on head lift, grip strength or tidal volume.
- Record the final ratio on the anaesthetic chart.
Why it matters
Residual block is common and linked to airway obstruction and pneumonia after surgery.
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