Evaluation of peripheral nerve stimulators and relationship to possible errors in assessing neuromuscular blockade

Voltage and current output characteristics were measured on six commercially available peripheral nerve stimulator devices. The results are evaluated as possible sources of variability in peripheral nerve stimulator function and neuromuscular blockade assessment. The authors found significant differences in output voltage waveform and in maximum current into a 470 ohm load (21.4 to 128 mA.). Output current decreased from 25 to 88% in the different devices, with a load impedance increase from 470 to 10,000 ohms. Due to the variability in peripheral nerve stimulation units and the decrease in current output at higher load impedance, less than supramaximal stimulation is possible with erroneous interpretation of neuromuscular blockade.