Neuromuscular Monitoring Advancement

Department of Anesthesiology, Lenox Hill Hospital, New York, New York. mdski@msn.comTo the Editor:—I read with interest the editorial view of Lars Eriksson, M.D., on evidence-based practice and neuromuscular monitoring. 1As Dr. Eriksson correctly presents, current subjective neuromuscular blockade monitoring is clearly inaccurate, often resulting in patients with some residual blockade in the PACU. 2–7However, to conclude that “the message is short and clear—it is time to move from discussion to action and introduce objective neuromuscular monitoring in all operating rooms” is unfortunate. There are currently no published outcome studies with respect to intermediate-acting muscle relaxants and residual weakness postoperatively. The “consequences” to which Dr. Eriksson refers in his editorial have never been related to any mortality/morbidity differences. His belief that this would improve patient outcome is unsupported.To advocate a new monitoring standard that would probably cost millions of dollars without outcome data to support such an expenditure is inappropriate. Just because other equipment has been introduced into medicine without outcome research does not justify the continuation of such behavior. That is not evidence-based medicine. Dr. Eriksson’s conclusion, although quite dramatic, is not presently justified.