The argument that quantitative monitoring with an electronic measuring device should be a de facto standard of care whenever nondepolarizing neuromuscular blockade is employed in anesthesia care has been offered to help reduce unrecognized postoperative residual weakness and the significant associated safety risks. In this comprehensive review, the authors detail the history and basics of neuromuscular blockade and its monitoring, including the 1970 introduction of the train-of-four stimulus and a force transducer to measure thumb adduction, and reports dating back to 1979 of the remarkably high incidence of postoperative residual neuromuscular block, including six cited studies of comparisons of quantitative monitoring vs. no monitoring that all showed dramatic reductions of residual block in the monitoring groups. Logically following is analysis of multiple reports of statistically significant decreases of postoperative adverse respiratory/pulmonary events in cohorts with quantitative monitoring. Prominently reprinted is a 2018 “consensus statement” from a self-appointed “panel of clinician scientists with expertise in neuromuscular blockade monitoring” that recommends objective quantitative monitoring as the only method of assuring satisfactory postoperative recovery of neuromuscular function. The authors note that the $15-30 cost of disposable electromyographic electrodes might be offset by drug cost savings and is “trivial” compared to the cost of a postoperative adverse pulmonary event. Multiple international editorials and review articles stating quantitative monitoring should be used are cited. The authors state: 1) anesthesia professionals must overcome any prior unsatisfactory experience with early generation monitors and their overconfidence in their clinical abilities to recognize neuromuscular recovery, and 2) a persistent intense campaign to promote adoption and use of quantitative neuromuscular monitoring will increase patient safety and enhance postoperative patient recovery.
Editor’s note: In the “Competing Interests” disclosure at the end of the article, it is noted that one author has served on the Scientific Advisory Board of a corporation that manufactures and sells a quantitative neuromuscular monitor and that the other is “a principal shareholder and Chief Medical Officer” of that corporation.
