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Neuromuscular Monitoring of Rocuronium 0.6 mg/kg in Children Aged 3-24 Months With Electromyography and

Sarah Sofie Wadland1, Karl Peter Damgård Madsen1, Mikkel Helmuth Jensen1

  • 1Department of Anesthesia, Centre of Head and Orthopedics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.

Paediatric Anaesthesia
|May 19, 2026
PubMed

Insights

Acceleromyography (AMG) offers faster train-of-four ratio (TOFR) recovery assessment than electromyography (EMG) at both the tibial and ulnar nerves in infants. This suggests AMG may underestimate neuromuscular blockade duration in pediatric patients.

Area of Science:

  • Anesthesiology and Perioperative Medicine
  • Pediatric Critical Care
  • Neurophysiology

Background:

  • Objective neuromuscular monitoring is crucial for preventing residual neuromuscular block in pediatric patients receiving neuromuscular blocking agents.
  • Quantitative monitoring at the ulnar nerve (UN) is challenging in infants due to equipment size limitations.
  • The tibial nerve (TN) presents an alternative monitoring site for pediatric neuromuscular assessment.

Purpose of the Study:

  • To compare train-of-four (TOF) monitoring using acceleromyography (AMG) and electromyography (EMG) at the tibial nerve (TN) and ulnar nerve (UN) in children aged 3-24 months.
  • To evaluate the time to reach a train-of-four ratio (TOFR) of ≥ 0.9 using both monitoring methods and nerve sites.

Main Methods:

  • An observational study included 107 pediatric patients undergoing elective surgery with general anesthesia and rocuronium (0.6 mg/kg).
  • Patients were monitored bilaterally at either the tibial nerve (TN) or ulnar nerve (UN) using both AMG and EMG.
  • Primary outcome was the time to achieve a TOFR ≥ 0.9; secondary outcomes included onset time and recovery of neuromuscular function.

Main Results:

  • At the tibial nerve (TN), the time to TOFR ≥ 0.9 was significantly shorter with AMG (81 min) compared to EMG (112 min).
  • At the ulnar nerve (UN), the time to TOFR ≥ 0.9 was also shorter with AMG (71 min) versus EMG (82 min).
  • Acceleromyography (AMG) demonstrated a significantly shorter recovery time at both nerve sites compared to electromyography (EMG).

Conclusions:

  • Time to TOFR ≥ 0.9 was significantly shorter with AMG compared to EMG at both UN and TN in children aged 3-24 months.
  • Acceleromyography (AMG) may underestimate the duration of neuromuscular blockade compared to electromyography (EMG) in this pediatric population.
  • Findings suggest potential implications for assessing recovery from neuromuscular blockade in infants.
Abstract

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