5.8
Neuromuscular Monitoring
- Short‐term paralysis is useful for intubation
- Longer procedural paralysis may be useful for controlled ventilation, lowering anesthesia dosage, and surgical relaxation
- It is always important to discuss with the surgeon neuromuscular blockade (paralysis) beyond the need for facilitation of endotracheal intubation as the surgical team may want to perform peripheral nerve testing
Clinical Evaluation
- Should not be used alone, but in conjunction with nerve monitoring
- Sustained head lift longer than five seconds
- Good grip strength
- Adequate tidal volumes
- An effective cough to clear secretions
- A negative inspiratory force of −25 cm H2O
Peripheral Nerve Stimulator
- Assists in qualitative assessment of neuromuscular blockade recovery
- Twitch
- A single burst to a muscle group
- Tetanus
- A sustained burst to a muscle group
- Train of Four
- Four consecutive twitches
- The most common method for evaluating neuromuscular blockade reversal (Figure 5.14)
- Fade
- The presence of a decreased twitch response in the fourth twitch compared to the first twitch during train of four stimulation
- Post‐Tetanic Twitch
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