A growing consensus for Neuromuscular Transmission Monitoring

Multiple societies all over the world recommend NMT monitoring in their national guidelines for the management of neuromuscular blockade. Visit your local anesthesia society webpage to learn more.

2023 American Society of Anesthesiologists Practice Guidelines for Monitoring and Antagonism of Neuromuscular Blockade

A Report by the American Society of Anesthesiologists Task Force on Neuromuscular Blockade

Anesthesiology 2023; 138:13–41

“The objective is to guide practice that will enhance patient safety by reducing residual neuromuscular blockade. It is recommended to use quantitative neuromuscular monitoring at the adductor pollicis and to confirm a recovery of train-of-four ratio greater than or equal to 0.9 before extubation.”

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Peri-operative management of neuromuscular blockade, European Society of Anaesthesiology and Intensive Care

A guideline from ESAIC

European Journal of Anaesthesiology 40(2):p 82-94, February 2023.

“We recommend the use of ulnar nerve stimulation and quantitative neuromuscular monitoring at the adductor pollicis muscle to exclude residual paralysis .”

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Recommendation for standard of monitoring during anaesthesia and recovery 2021, UK and Ireland

Guideline from the Association of Anaesthetists published by Anaesthesia May 2021

“Quantitative neuromuscular monitoring should be used whenever neuromuscular blocking (NMB) drugs are administered, throughout all phases of anaesthesia from before initiation of neuromuscular blockade until recovery of the train-of-four ratio to > 0.9 has been confirmed.”

GUIDELINES TO THE PRACTICE OF ANESTHESIA, Revised Edition 2020, Canadian Anesthesiologists´Society (CAS)

Published by Canadian Journal of Anesthesia, Vol. 67 No 1

The recommendation for the use of neuromuscular monitoring when neuromuscular blocking agents are administered has been strengthened from ‘‘should’’ to ‘‘must’’ be utilized. Neuromuscular blockade monitors are now considered ‘‘required’’ equipment when previously they were ‘‘exclusively available’’ when neuromuscular blocking agents are used.

Guidelines of muscle relaxants and reversal in anesthesia, Société Francaise d´Anesthésie et Réanimation (SFAR) 2020

Published by Anesthesia Critical Care & Pain Medicine Vol.39 Issue 1

The SFAR recommends intraoperative monitoring of neuromuscular blockade throughout anaesthesia when a muscle relaxant is administered. This recommendation applies both in the operating theatre and the post-anaesthesia care unit.

Qualitative measurement of the ratio between the fourth and first TOF response (T4/T1) of >0.9 is required to eliminate a diagnosis of residual neuromuscular blockade.

Guidelines on Neuromuscular Monitoring and Antagonism, SIAARTI Italy March 21, 2018

This document provided by SIAARTI (The Italian Society of Anesthesia, Analgesia, Reanimation and Intensive Care) establishes the general criteria for the use of Blocking agents and Neuromuscular Monitoring.

Consensus Statement on Perioperative Use of Neuromuscular Monitoring

This statement was published online at www.anesthesia-analgesia.org on November 30, 2017 (2018 in press), Copyright 2017 International Anesthesia Research Society.

A panel of clinician scientists with expertise in neuromuscular blockade (NMB) monitoring was convened with a charge to prepare a consensus statement on indications for, and proper use of, such monitors.

Helsinki Declaration on patient safety in Anaesthesiology

Published by European Society of Anaesthesiology

Anaesthesiology shares responsibility for quality and safety in Anaesthesia, Intensive Care, Emergency Medicine and Pain Medicine, including the whole perioperative process and also in many other situations inside and outside the hospital where patients are at their most vulnerable. Around 230 million patients undergo anaesthesia for major surgery in the world every year. Seven million develop severe complications associated with these surgical procedures from which one million die (200,000 in Europe).1 All involved should try to reduce this complication rate significantly. Anaesthesiology is the key specialty in medicine to take up responsibility for achieving the goals listed below which will notably improve Patient Safety in Europe.

International Standards for a Safe Practice of Anesthesia 2010

Adopted by the World Federation of Societies of Anaesthesiologists

These standards are recommended for anesthesia professionals throughout the world. They are intended to provide guidance and assistance to anesthesia professionals, their professional societies, hospital and facility administrators, and governments for improving and maintaining the quality and safety of anesthesia care. They were adopted by the World Federation of Societies of Anaesthesiologists on the 13th June 1992, and revisions were ratified on 5th March 2008 and on 19th March 2010.

Recommendations for standards of monitoring during anaesthesia and recovery 2015

Published by The Association of Anaesthetists of Great Britain & Ireland

The aim of this document is to provide guidance on the minimum standards for physiological monitoring of any patient undergoing anaesthesia or sedation under the care of an anaesthetist.

Guidelines on Monitoring During Anaesthesia

Published by Australian and New Zealand College of Anaesthetists (ANZCA)


Published by Australian and New Zealand College of Anaesthetists (ANZCA)

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