Monitoring of neuromuscular transmission

Considerable advances have been achieved in developing new techniques and equipment for the assessment of neuromuscular transmission during anaesthesia. This paper is a review of the methods currently used in research as well as in daily clinical practice. The principles of nerve stimulation and the evoked muscular response, the function of the nerve stimulator, features of the stimulation electrodes, possible stimulation sites, and the various stimulation patterns with their responses are described. The methods for measurement of neuromuscular function with mechanomyography, electromyography and acceleromyography are reviewed, and commercially available equipment for each purpose is described. The clinical evaluation of the responses to nerve stimulation, and which stimulation patterns to prefer during onset, maintenance and recovery of neuromuscular block are dealt with, as well as possible errors to be encountered. Arguments are given for routine use of neuromuscular monitoring in the clinical setting, and situations where monitoring of neuromuscular function are of particular importance are noted.