Recovery of train of four ratio to > 0.9 signifies adequate recovery of muscle function after neuromuscular blockade.

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• E Baumüller, S J Schaller, Y Chiquito Lama, C G Frick, T Bauhofer, M Eikermann, H Fink, and M Blobner.
• Klinik für Anaesthesiologie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675 München, Germany eva.baumueller@lrz.tu-muenchen.de.
• Br J Anaesth. 2015 May 1; 114 (5): 785-93.

BackgroundA train-of-four ratio (TOFR) ≥0.9 measured by quantitative neuromuscular monitoring is accepted as an indication of sufficient neuromuscular recovery for extubation, even though many postsynaptic acetylcholine receptors may still be inhibited. We investigated whether antagonism with sugammadex after spontaneous recovery to TOFR≥0.9 further improves muscle function or subjective well-being.MethodsFollowing recovery to TOFR≥0.9 and emergence from anaesthesia, 300 patients randomly received either sugammadex 1.0 mg kg(-1) or placebo. Fine motor function (Purdue Pegboard Test) and maximal voluntary grip strength were measured before and after surgery (before and after test drug administration). At discharge from the postanaesthesia care unit, well-being was assessed with numerical analogue scales and the Quality-of-Recovery Score 40 (QoR-40).ResultsPatients' fine motor function [6 (sd 4) vs 15 (3) pegs (30 s)(-1), P<0.05] and maximal voluntary grip strength (284 (126) vs 386 (125) N, P<0.05) were significantly lower after anaesthesia compared with the pre-anaesthesia baseline. After sugammadex or placebo, motor function was significantly improved in both groups but did not reach the preoperative level. There was no difference between groups at any time. Global well-being was unaffected (QoR-40: placebo, 174 vs 185; sugammadex, 175 vs 186, P>0.05).ConclusionsAntagonizing rocuronium at TOF≥0.9 with sugammadex 1.0 mg kg(-) (1) did not improve patients' motor function or well-being when compared with placebo. Our data support the view that TOFR≥0.9 measured by electromyography signifies sufficient recovery of neuromuscular function.Clinical Trial RegistrationThe trial is registered at ClinicalTrials.gov (NCT01101139).© The Author 2014. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

This article appears in the collection: Neuromuscular myths: the lies we tell ourselves.

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