Reversing Neuromuscular Blockade without Nerve Stimulator Guidance in a Postsurgical ICU—An Observational Study

Figure 1. (a)—RNB pre-neostigmine administration—histogram indicating number of patients at each Train-of-Four Count (TOFC) or Train-of-Four Ratio (TOFR) as their level of residual neuromuscular blockade (RNB) when analyzed at the preneostigmine administration time point. Total number of patients evaluated = 104. (b)—RNB pre-extubation—histogram indicating number of patients at each Train-of-Four Count (TOFC) or Train-of-Four Ratio (TOFR) as their level of residual neuromuscular blockade (RNB) when analyzed at the pre-extubation time point. Total number of patients evaluated = 94.

Figure 2. Relation of RNB pre-neostigmine vs. pre-extubation—dot plot indicating the pre-extubation accelerometry level achieved as a function of the level of residual neuromuscular blockade (RNB) present at the time of neostigmine administration. X-axis indicates the patients achieving various levels of Train-of-Four Count (TOFC) or Train-of-Four Ratio (TOFR) at the pre-neostigmine administration time point. Y-axis indicates the accelerometry level achieved at the pre-extubation time point for individual patients within each pre-neostigmine level of TOFC or TOFR. Accelerometry level of “0” indicates patients whose pre-extubation RNB was less than TOFC 4 and therefore could not be quantified by acceleromyograhphy. Ninety-three of ninety-four patients had RNB values obtained at both pre-neostigmine and pre-extubation time points. One excluded patient had post-extubation TOFC 4 but no indication of TOFR associated with this.