Fig. 2. Proposed decision algorithm for reversal of residual paralysis during emergence taking into account the level of neuromuscular block at that time visually or tactilely estimated with train-of-four (TOF) stimulation at the adductor pollicis (AP) and available reversal agent: (A ) acetylcholinesterase inhibitor combined with an anticholinergic agent or (B ) sugammadex alone. Before TOF ratio (TOFR) estimation, check the neuromuscular monitor (e.g. , electrode positions and polarity, current intensity ≥ 40 mA) and central temperature (e.g. , ≥ 36.5°C). When available and regardless of the therapeutic decision, quantitative assessment of TOFR is recommended. NMBD = nondepolarizing neuromuscular blocking drug; PTC = posttetanic count. * This situation has only been tested with rocuronium.