Train-of-Four monitoring: overestimation

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http:// creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. CC According to a survey on the use of muscle relaxants, there are a lot of cases where routine monitoring of the neuromuscular junction using a nerve stimulator is not applied, nor is quantitative evaluation of the Train of Four (TOF) performed when using a non-depolarizing muscle relaxant. Moreover, the need for monitoring is itself being questioned [1]. Thus, unless the physician has a special interest in monitoring the effect of muscle relaxants, there is a lack of interest in the correct method of monitoring. Therefore, it is essential to promote the need for accurate monitoring when using muscle relaxants through education, especially when the incomplete block of the neuromuscular junction is in question. Monitoring of the neuromuscular junction can be an effective method in determining the dose and time of administration of muscle relaxants for induction or intubation, especially where deep muscular relaxation is required to repress detrimental reflexes. It is also useful in cases where maintenance of muscle relaxation is continuously required, to identify residual muscle relaxation during recovery from anesthesia, during long periods of mechanical ventilation, or in cases where a motor evoked potential is monitored during surgery.