At the conclusion of procedures where a nondepolarizing muscle relaxant was used, the benefits of anticholinesterase reversal must be balanced with potential risks. When the train-of-four ratio has spontaneously returned to 0.9 or higher, some experts have recommended against the routine use of neostigmine because this agent itself can produce muscle weakness. In this issue of Anesthesiology, Murphy et al. demonstrate that administration of neostigmine at neuromuscular recovery was not associated with clinical evidence of paradoxical anticholinesterase-induced muscle weakness. In an accompanying Editorial View, Brull and Naguib discuss evidence against many of the myths surrounding reversal of neuromuscular blockade.

  • Murphy et al.: Neostigmine Administration after Spontaneous Recovery to a Train-of-Four Ratio of 0.9 to 1.0: A Randomized Controlled Trial of the Effect on Neuromuscular and Clinical Recovery, p. 27

  • Brull and Naguib: How to Catch Unicorns (and Other Fairytales), p. 1