Neuromuscular monitoring - 2025
Neuromuscular blocking agents (NMBA) are drugs with potentially life threatening effects for the patient. Therefore the monitoring of neuromuscular transmission during the operation is done according to the Czech Society of Anaesthesia, Resuscitation and Intensive Care and it is considered to be a standard procedure in patients care. The objective evaluation of the depth of relaxation gives the anaesthesiologist a valuable information that aids in his decision making about the immediate care. The main goal of this algorithm is to introduce the audience to the basic informations and options about neuromuscular monitoring and furthemore, to point to its importance in bringing the best possible care to the patient according to the European guidelines of 2024.
Review
The presented algorithm for solving clinical situations related to the correct practice of monitoring neuromuscular blockade and its reversal at the end of surgery is an excellent example of the systematic didactic activities of the Akutně.cz portal. The decision-making processes described in the algorithm are based on practice, contain recent information, and are beneficial not only for students or young doctors.
Sources
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Learning targets
2. The student can recognize different methods and modes of neuromuscular relaxation monitoring.
3. The student understands the principle of antagonizing neuromuscular blockade using different muscle relaxants.
Key points
2. The standard method for objective monitoring of muscle relaxation is TOF, PTC mode is used for deep blockade.
3. A safe TOF ratio value that excludes residual curarization is > 0.9, otherwise reversal is necessary. Sugammadex is a specific antagonist for rocuronium and vecuronium; neostigmine with atropine is used to antagonize other non-depolarizing relaxants.
