Consensus Statement on Perioperative Use of Neuromuscular Monitoring.

Area of Science:

• Anesthesiology
• Pharmacology
• Critical Care Medicine

Background:

• Neuromuscular blockade (NMB) is commonly used in anesthesia and critical care.
• Current monitoring practices for NMB recovery vary, with a reliance on subjective assessments.
• Objective monitoring is crucial for ensuring adequate recovery and patient safety.

Purpose of the Study:

• To provide the scientific rationale for quantitative NMB monitoring.
• To establish recommendations for quantitative NMB monitoring standards.
• To define educational and training goals for proper neuromuscular monitoring.

Main Methods:

• A consensus statement developed by a panel of clinician scientists expert in NMB monitoring.
• Review of the scientific basis for quantitative NMB monitoring.
• Formulation of recommendations for monitoring standards, education, and training.

Main Results:

• Quantitative NMB monitoring, ideally at hand muscles, is recommended for all patients receiving neuromuscular blockers.
• Objective monitoring, defined by a train-of-four ratio ≥0.90, is the only reliable method to confirm satisfactory recovery.
• Subjective evaluations and clinical tests for NMB recovery should be abandoned in favor of objective monitoring.

Conclusions:

• Adoption of quantitative NMB monitoring requires active promotion by professional societies and institutional leadership.
• Standardized objective monitoring ensures patient safety by confirming complete reversal of neuromuscular blockade.
• Education and training are essential to implement and sustain proper neuromuscular monitoring practices.