Neuromuscular monitoring

In anesthesia, neuromuscular blocking agents may be required to facilitate endotracheal intubation and provide optimal surgical conditions.

[4] In train of four monitoring, "peripheral nerve stimulation can ensure proper medication dosing and thus decrease the incidence of side effects" by "assessing the depth of neuromuscular blockade".

[12] The response of the muscle to stimulation of the nerve supplying it can be assessed by subjective (visual or tactile) techniques or quantitative (objective) devices that provide a numeric value relating to the depth of neuromuscular blockade.

The mechanical response to stimulation of the muscle can be measured by mechanomyography, kinemyography and acceleromyography[13] In 2018 recommendations by an international panel of experts on neuromuscular monitoring to assist anaesthesia care providers and professional organisations that develop practice advisories and guidelines regarding the minimum standards for monitoring patients that receive neuromuscular blockade (NMB) during anaesthesia.

[15] These included that a peripheral nerve stimulator is mandatory for all patients receiving neuromuscular blocking drugs and that they should be applied and used from induction (to confirm adequate muscle relaxation before intubation) until recovery from blockade and return of consciousness.