We investigate claims about reversal of neuromuscular blockade. 

Claim 1. Location of train-of-four assessment matters

Claim 2. Train-of-four is unnecessary with "sufficient" time from the last dose 

Claim 3. Fade can be discriminated by tactile assessment

Our guest today is Dr. Daniel Saddawi-Konefka of the Massachusetts General Hospital.   

Full show notes available at depthofanesthesia.com. 

Connect with us @DepthAnesthesia on Twitter or depthofanesthesia@gmail.com.

Thanks for listening! Please rate us on iTunes and share with your colleagues. 

Music by Stephen Campbell, MD. 

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References

Arain Sr, Kern S, Ficke DJ, Ebert TJ. Variability of duration of action of neuromuscular blocking drugs in elderly patients. Acta Anaesthesiol Scand. 2005;49:312–315. 

Caldwell JE. Reversal of residual neuromuscular block with neostigmine at one to four hours after a single intubating dose of vecuronium. Anesth Analg 1995;80:1168 –74

JØRGEN VIBY-MOGENSEN, NIELS HENRIK JENSEN, JENS ENGBAEK, HELLE ØRDING, LENE THEIL SKOVGAARD, BENT CHRAEMMER-JØRGENSEN; Tactile and Visual Evaluation of the Response to Train-of-four Nerve Stimulation. Anesthesiology1985;63(4):440-442.

Stephan R. Thilen, Bradley E. Hansen, Ramesh Ramaiah, Christopher D. Kent, Miriam M. Treggiari, Sanjay M. Bhananker; Intraoperative Neuromuscular Monitoring Site and Residual Paralysis. Anesthesiology 2012;117(5):964-972. doi: 10.1097/ALN.0b013e31826f8fdd.

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By listening to this podcast, you agree not to use information as medical advice to treat any medical condition in either yourself or others, including but not limited to patients that you are treating. Opinions expressed are solely those of the host and guests and do not express the views or opinions of Massachusetts General Hospital.