Many readers may now be familiar with the new ASA practice guidelines for monitoring and antagonism of neuromuscular blockade that were published this past January (Anesthesiology 2023;138:13-41). For those who are not, this article may serve as a brief overview of the advances made in neuromuscular monitoring in recent years and the considerations of practical application to general anesthesia practices.

In terms of monitoring neuromuscular blockade, train-of-four qualitative peripheral nerve stimulators have been in regular use since the 1970s. In general, these devices are deceptively user-friendly and easy to place on patients, requiring just two electrodes. By measuring the patient's response to four brief electrical impulses, a level of blockade can be roughly estimated. Major drawbacks to this technique include varying degrees of accuracy based on placement location and the subjective nature of measuring twitches themselves. Residual neuromuscular blockade observed in the postanesthesia care unit (PACU) can be...

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