Reversal of neuromuscular blockade

Intelligent, safe use of muscle relaxants dictates that the clinician monitor neuromuscular function in all patients to determine each patient's sensitivity to relaxants. Restoration of muscle strength is a function of pharmacological antagonism of residual NMB, spontaneous recovery as the concentration of relaxant declines at the neuromuscular junction, or both. In addition to recovery of "normal function" by clinical and monitoring criteria, some margin of safety of neuromuscular function must be restored. As new relaxants with very short half-lives become available, it is likely that steady states of relaxation will increasingly be maintained with continuous infusions. In this setting, the rapid rate of spontaneous recovery of both clinical neuromuscular function and an adequate margin of safety may vastly reduce the need for pharmacological antagonism.