• Satoshi Kazuma, Keiko Wakasugi, Hiroya Hagiwara, and Michiaki Yamakage.
• From the Department of Anesthesiology, Sapporo Medical University School of Medicine, Hokkaido, Japan.
• Anesth. Analg. 2019 Jul 1; 129 (1): e16-e19.

AbstractTrain-of-four ratios were recorded to assess the agreement between the TOF-Cuff and TOF-Watch, and residual paresis was assessed to evaluate the clinical utility of TOF-Cuff. Train-of-four ratios were evaluated using Lin concordance correlation coefficient and Bland-Altman analyses. Measured train-of-four ratios demonstrated high accuracy and precision over the entire range of train-of-four ratios. Although precision and Lin concordance correlation coefficients decreased with train-of-four ratios >0.7, none of the patients showed signs of residual paresis. Because TOF-Cuff underestimated train-of-four ratios in the recovery period, the clinical safety of train-of-four ratios >0.9 indicated by TOF-Cuff is unclear; the issue of residual paresis requires future research that rigorously evaluates outcomes.

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