Recovery from neuromuscular blockade: a survey of practice

At present in the UK there is no consensus regarding the parameters anaesthetists use to indicate adequacy of reversal from neuromuscular blockade. In an attempt to determine current practice, we carried out a survey covering 12 anaesthetic departments throughout the UK. Individuals were asked to give details regarding their usage of available monitors or, alternatively, to list those clinical parameters which they felt offered the best guidance as to the adequacy of recovery from neuromuscular blockade. There was no consensus among anaesthetists as to the most reliable clinical signs of recovery from neuromuscular blockade. There was an apparent lack of understanding of the limitations of some clinical signs used to determine recovery, as well as inappropriate application of others. In all departments where monitors (quantitative or qualitative) were available, there was limited knowledge regarding the current minimum recommended train-of-four ratio which should be observed prior to extubation. There is an apparent overall confusion among clinicians as to the best method to confirm recovery from neuromuscular blockade. This is probably due to the lack of a single reliable clinical test which can be applied in the immediate postoperative period. Insufficient reliance is placed upon the use of quantitative monitors. There is a lack of clarity in national anaesthetic guidelines with respect to monitoring of neuromuscular function. Current standards need to be re-assessed in the light of recent improvements in nerve stimulators.