Residual neuromuscular block after non-depolarising relaxants is common and associated with hypoxaemia, aspiration and reintubation. Clinical signs such as head lift and tidal volume are unreliable at detecting it.
Quantitative monitoring of the train-of-four ratio at the adductor pollicis, aiming for 0.9 or more before extubation, is the reliable check.
- Use quantitative train-of-four monitoring whenever a non-depolarising relaxant is given
- Confirm a train-of-four ratio of at least 0.9 before extubation
- Do not rely on head lift or grip strength to exclude residual block
- Give reversal guided by the measured depth of block
Why it matters
Residual block is frequent, clinically silent and avoidable with a simple measurement.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for anaesthesiology, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free