Current Anesthesiology Reports

, Volume 8, Issue 2, pp 134–144 | Cite as

Quantitative Neuromuscular Monitoring: Current Devices, New Technological Advances, and Use in Clinical Practice

  • Hajime Iwasaki
  • Reka Nemes
  • Sorin J. Brull
  • J. Ross Renew
Neuromuscular Blockade (GS Murphy, Section Editor)
Part of the following topical collections:
  1. Neuromuscular Blockade


Purpose of Review

The purpose of this review is to summarize various quantitative neuromuscular monitoring modalities and describe strategies to implement them into routine practice. We will contrast these objective modalities with unreliable clinical tests and subjective techniques that expose patients to unnecessary risk associated with postoperative residual weakness.

Recent Findings

As major specialty societies publish guidelines and consensus statements urging anesthesiologists to utilize quantitative monitors, clinicians must familiarize themselves with this equipment. Furthermore, new monitors are emerging as the industry tries to address the need for user-friendly, reliable monitors.


Clinical assessment is an unacceptable technique to guide neuromuscular blockade management in patients receiving neuromuscular blocking agents. The use of a peripheral nerve stimulator can provide some information regarding the level of neuromuscular blockade in patients; however, it cannot reliably confirm adequate recovery. The use of objective, quantitative monitoring is an essential practice that helps guide the administration of neuromuscular blocking agents and excludes deleterious postoperative residual weakness.


Quantitative monitoring Residual muscle weakness Neuromuscular blockade Patient safety 


Compliance with Ethical Standards

Conflict of Interest

Hajime Iwasaki declares that he has no conflict of interest.

Reka Nemes is supported by a visiting student researcher grant from the J. William Fulbright Scholarship Board.

Sorin J. Brull has received research support through a grant from Merck (with funds to Mayo Clinic); has received compensation from Senzime AB for service on the Board of Directors; has served on scientific advisory boards for The Doctors Company, ClearLine MD, and NMD Pharma; and has a patent pending for neuromuscular display licensed to Mayo Clinic.

J. Ross Renew has received research support through a grant from Merck (with funds to Mayo Clinic).

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors..


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Murphy GS, Brull SJ. Residual neuromuscular block: lessons unlearned. Part I: definitions, incidence, and adverse physiologic effects of residual neuromuscular block. Anesth Analg. 2010;111(1):120–8.CrossRefPubMedGoogle Scholar
  2. 2.
    Bevan DR, Smith CE, Donati F. Postoperative neuromuscular blockade: a comparison between atracurium, vecuronium, and pancuronium. Anesthesiology. 1988;69(2):272–6.CrossRefPubMedGoogle Scholar
  3. 3.
    Khuenl-Brady KS, Wattwil M, Vanacker BF, Lora-Tamayo JI, Rietbergen H, Álvarez-Gómez JA. Sugammadex provides faster reversal of vecuronium-induced neuromuscular blockade compared with neostigmine: a multicenter, randomized, controlled trial. Anesth Analg. 2010;110(1):64–73.CrossRefPubMedGoogle Scholar
  4. 4.
    Todd MM, Hindman BJ, King BJ. The implementation of quantitative electromyographic neuromuscular monitoring in an academic anesthesia department. Anesth Analg. 2014;119(2):323–31.CrossRefPubMedGoogle Scholar
  5. 5.
    Murphy GS, Szokol JW, Avram MJ, Greenberg SB, Marymont JH, Vender JS, et al. Intraoperative acceleromyography monitoring reduces symptoms of muscle weakness and improves quality of recovery in the early postoperative period. Anesthesiology. 2011;115(5):946–54.CrossRefPubMedGoogle Scholar
  6. 6.
    • Todd MM, Hindman BJ. The implementation of quantitative electromyographic neuromuscular monitoring in an academic anesthesia department: follow-up observations. Anesth Analg. 2015;121(3):836–8. An excellent report which shows that the implementation of appropriate quantitative neuromuscular monitoring and staff education can eliminate major respiratory events associated with residual neuromuscular weakness. CrossRefPubMedGoogle Scholar
  7. 7.
    Naguib M, Kopman AF, Lien CA, Hunter JM, Lopez A, Brull SJ. A survey of current management of neuromuscular block in the United States and Europe. Anesth Analg. 2010;111(1):110–9.CrossRefPubMedGoogle Scholar
  8. 8.
    •• Checketts MR, Alladi R, Ferguson K, Gemmell L, Handy JM, Klein AA, et al. Recommendations for standards of monitoring during anaesthesia and recovery 2015: Association of Anaesthetists of Great Britain and Ireland. Anaesthesia. 2016;71(1):85–93. A recent guideline from Great Britain and Ireland mandating the use of neuromuscular monitoring when NMBAs are administered. CrossRefPubMedGoogle Scholar
  9. 9.
    •• Naguib M, et al. Consensus statement on perioperative use of neuromuscular monitoring. Anesth Analg. 2017; A recent consensus statement from the US mandating the use of neuromuscular monitoring when NMBAs are administered.
  10. 10.
    Dam WH, Guldmann N. Inadequate postanesthetic ventilation. Curare, anesthetic, narcotic, diffusion hypoxia. Anesthesiology. 1961;22:699–707.CrossRefPubMedGoogle Scholar
  11. 11.
    Ali HH, Utting JE, Gray TC. Quantitative assessment of residual antidepolarizing block. II. Br J Anaesth. 1971;43(5):478–85.CrossRefPubMedGoogle Scholar
  12. 12.
    Kopman AF, Yee PS, Neuman GG. Relationship of the train-of-four fade ratio to clinical signs and symptoms of residual paralysis in awake volunteers. Anesthesiology. 1997;86(4):765–71.CrossRefPubMedGoogle Scholar
  13. 13.
    Eikermann M, Groeben H, Hüsing J, Peters J. Accelerometry of adductor pollicis muscle predicts recovery of respiratory function from neuromuscular blockade. Anesthesiology. 2003;98(6):1333–7.CrossRefPubMedGoogle Scholar
  14. 14.
    Russell WJ, Serle DG. Hand grip force as an assessment of recovery from neuromuscular block. J Clin Monit. 1987;3(2):87–9.CrossRefPubMedGoogle Scholar
  15. 15.
    Kelly D, Brull SJ. Monitoring of neuromuscular function in the clinical setting. Yale J Biol Med. 1993;66(5):473–89.PubMedPubMedCentralGoogle Scholar
  16. 16.
    Viby-Mogensen J, et al. Tactile and visual evaluation of the response to train-of-four nerve stimulation. Anesthesiology. 1985;63(4):440–3.CrossRefPubMedGoogle Scholar
  17. 17.
    Drenck NE, Ueda N, Olsen NV, Engbœk J, Jensen E, Skovgaard LT, et al. Manual evaluation of residual curarization using double burst stimulation: a comparison with train-of-four. Anesthesiology. 1989;70(4):578–81.CrossRefPubMedGoogle Scholar
  18. 18.
    Brull SJ, Silverman DG. Visual and tactile assessment of neuromuscular fade. Anesth Analg. 1993;77(2):352–5.CrossRefPubMedGoogle Scholar
  19. 19.
    Gissen AJ, Katz RL. Twitch, tetanus and posttetanic potentiation as indices of nerve-muscle block in man. Anesthesiology. 1969;30(5):481–7.CrossRefPubMedGoogle Scholar
  20. 20.
    Ali HH, Utting JE, Gray C. Stimulus frequency in the detection of neuromuscular block in humans. Br J Anaesth. 1970;42(11):967–78.CrossRefPubMedGoogle Scholar
  21. 21.
    Ali HH, Savarese JJ. Stimulus frequency and dose-respone curve to d-tubocurarine in man. Anesthesiology. 1980;52(1):36–9.CrossRefPubMedGoogle Scholar
  22. 22.
    Eikermann M, Peters J. Nerve stimulation at 0.15 Hz when compared to 0.1 Hz speeds the onset of action of cisatracurium and rocuronium. Acta Anaesthesiol Scand. 2000;44(2):170–4.CrossRefPubMedGoogle Scholar
  23. 23.
    Lee C, Katz RL. Neuromuscular pharmacology. A clinical update and commentary. Br J Anaesth. 1980;52(2):173–88.CrossRefPubMedGoogle Scholar
  24. 24.
    Capron F, Fortier LP, Racine S??, Donati F?? Tactile fade detection with hand or wrist stimulation using train-of-four, double-burst stimulation, 50-hertz tetanus, 100-hertz tetanus, and acceleromyography. Anesth Analg. 2006;102(5):1578–84.CrossRefPubMedGoogle Scholar
  25. 25.
    Iwasaki H, Renew JR, Kunisawa T, Brull SJ. Preparing for the unexpected: special considerations and complications after sugammadex administration. BMC Anesthesiol. 2017;17(1):140.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Brull SJ, Ehrenwerth J, Silverman DG. Stimulation with submaximal current for train-of-four monitoring. Anesthesiology. 1990;72(4):629–32.CrossRefPubMedGoogle Scholar
  27. 27.
    Gibson FM, Mirakhur RK, Clarke RSJ, Brady MM. Quantification of train-of-four responses during recovery of block from non-depolarising muscle relaxants. Acta Anaesthesiol Scand. 1987;31(7):655–7.CrossRefPubMedGoogle Scholar
  28. 28.
    Kopman AF, Naguib M. Laparoscopic surgery and muscle relaxants: is deep block helpful? Anesth Analg. 2015;120(1):51–8.CrossRefPubMedGoogle Scholar
  29. 29.
    Kirov K, Motamed C, Ndoko SK, Dhonneur G. TOF count at corrugator supercilii reflects abdominal muscles relaxation better than at adductor pollicis. Br J Anaesth. 2007;98(5):611–4.CrossRefPubMedGoogle Scholar
  30. 30.
    Engbaek J, Ostergaard D, Viby-Mogensen J. Double burst stimulation (DBS): a new pattern of nerve stimulation to identify residual neuromuscular block. Br J Anaesth. 1989;62(3):274–8.CrossRefPubMedGoogle Scholar
  31. 31.
    Saitoh Y, et al. Evaluation of residual neuromuscular blockade using modified double burst stimulation. Acta Anaesthesiol Scand. 1997;41(6):741–5.CrossRefPubMedGoogle Scholar
  32. 32.
    Samet A, Capron F, Alla F??, Meistelman C, Fuchs-Buder T. Single acceleromyographic train-of-four, 100-Hertz tetanus or double-burst stimulation: which test performs better to detect residual paralysis? Anesthesiology. 2005;102(1):51–6.CrossRefPubMedGoogle Scholar
  33. 33.
    Tassonyi E. A new concept in the measurement of neuromuscular transmission and block. Anaesthesist. 1975;24(8):374–7.PubMedGoogle Scholar
  34. 34.
    Viby-Mogensen J, Howardy-Hansen P, Chræmmer-Jørgensen B, Ørding H, Engbæk J, Nielsen A. Posttetanic count (PTC): a new method of evaluating an intense nondepolarizing neuromuscular blockade. Anesthesiology. 1981;55(4):458–61.CrossRefPubMedGoogle Scholar
  35. 35.
    Brull SJ, Connelly NR, OʼConnor TZ, Silverman DG. Effect of tetanus on subsequent neuromuscular monitoring in patients receiving vecuronium. Anesthesiology. 1991;74(1):64–70.CrossRefPubMedGoogle Scholar
  36. 36.
    Brull SJ, Silverman DG. Tetanus-induced changes in apparent recovery after bolus doses of atracurium or vecuronium. Anesthesiology. 1992;77(4):642–5.CrossRefPubMedGoogle Scholar
  37. 37.
    Hakim D, Drolet P, Donati F, Fortier LP. Performing post-tetanic count during rocuronium blockade has limited impact on subsequent twitch height or train-of-four responses. Can J Anaesth. 2016;63(7):828–33.CrossRefPubMedGoogle Scholar
  38. 38.
    El-Orbany MI, Joseph NJ, Salem MR. The relationship of posttetanic count and train-of-four responses during recovery from intense cisatracurium-induced neuromuscular blockade. Anesth Analg. 2003;97(1):80–4.CrossRefPubMedGoogle Scholar
  39. 39.
    Johnson MA, Sideri G, Weightman D, Appleton D. A comparison of fibre size, fibre type constitution and spatial fibre type distribution in normal human muscle and in muscle from cases of spinal muscular atrophy and from other neuromuscular disorders. J Neurol Sci. 1973;20(4):345–61.CrossRefPubMedGoogle Scholar
  40. 40.
    Ibebunjo C, Srikant CB, Donati F. Properties of fibres, endplates and acetylcholine receptors in the diaphragm, masseter, laryngeal, abdominal and limb muscles in the goat. Can J Anaesth. 1996;43(5 Pt 1):475–84.CrossRefPubMedGoogle Scholar
  41. 41.
    Fuchs-Buder T, Schreiber JU. A train-of-four count should be a train-of-four count, independently of the method it was determined with. Anesthesiology. 2012;116(6):1395–6; author reply 1396-7.CrossRefPubMedGoogle Scholar
  42. 42.
    Bevan DR, Donati F, Kopman AF. Reversal of neuromuscular blockade. Anesthesiology. 1992;77(4):785–805.CrossRefPubMedGoogle Scholar
  43. 43.
    Eriksson LI, Sundman E, Olsson R, Nilsson L, Witt H, Ekberg O, et al. Functional assessment of the pharynx at rest and during swallowing in partially paralyzed humans: simultaneous videomanometry and mechanomyography of awake human volunteers. Anesthesiology. 1997;87(5):1035–43.CrossRefPubMedGoogle Scholar
  44. 44.
    Eikermann M, Vogt FM, Herbstreit F, Vahid-Dastgerdi M, Zenge MO, Ochterbeck C, et al. The predisposition to inspiratory upper airway collapse during partial neuromuscular blockade. Am J Respir Crit Care Med. 2007;175(1):9–15.CrossRefPubMedGoogle Scholar
  45. 45.
    Phillips S, Stewart PA, Freelander N, Heller G. Comparison of evoked electromyography in three muscles of the hand during recovery from non-depolarising neuromuscular blockade. Anaesth Intensive Care. 2012;40(4):690–6.PubMedGoogle Scholar
  46. 46.
    Hemmerling TM, Michaud G, Babin D, Trager G, Donati F. Comparison of phonomyography with balloon pressure mechanomyography to measure contractile force at the corrugator supercilii muscle. Can J Anaesth. 2004;51(2):116–21.CrossRefPubMedGoogle Scholar
  47. 47.
    Katz RL. Electromyographic and mechanical effects of suxamethonium and tubocurarine on twitch, tetanic and post-tetanic responses. Br J Anaesth. 1973;45(8):849–59.CrossRefPubMedGoogle Scholar
  48. 48.
    Kitajima T, Ishii K, Kobayashi T, Ogata H. Differential effects of vecuronium on the thumb and great toe as measured by accelography and electromyography. Anaesthesia. 1995;50(1):76–8.CrossRefPubMedGoogle Scholar
  49. 49.
    Kern SE, Johnson JO, Orr JA, Westenskow DR. Clinical analysis of the flexor hallucis brevis as an alternative site for monitoring neuromuscular block from mivacurium. J Clin Anesth. 1997;9(5):383–7.CrossRefPubMedGoogle Scholar
  50. 50.
    Heier T, Hetland S. A comparison of train-of-four monitoring: mechanomyography at the thumb vs acceleromyography at the big toe. Acta Anaesthesiol Scand. 1999;43(5):550–5.CrossRefPubMedGoogle Scholar
  51. 51.
    Saitoh Y, Fujii Y, Takahashi K, Makita K, Tanaka H, Amaha K. Recovery of post-tetanic count and train-of-four responses at the great toe and thumb. Anaesthesia. 1998;53(3):244–8.CrossRefPubMedGoogle Scholar
  52. 52.
    Debaene B, Beaussier M, Meistelman C, Donati F, Lienhart A. Monitoring the onset of neuromuscular block at the orbicularis oculi can predict good intubating conditions during atracurium-induced neuromuscular block. Anesth Analg. 1995;80(2):360–3.PubMedGoogle Scholar
  53. 53.
    Hemmerling TM, Donati F, Beaulieu P, Babin D. Phonomyography of the corrugator supercilii muscle: signal characteristics, best recording site and comparison with acceleromyography. Br J Anaesth. 2002;88(3):389–93.CrossRefPubMedGoogle Scholar
  54. 54.
    Plaud B, Debaene B, Donati F. The corrugator supercilii, not the orbicularis oculi, reflects rocuronium neuromuscular blockade at the laryngeal adductor muscles. Anesthesiology. 2001;95(1):96–101.CrossRefPubMedGoogle Scholar
  55. 55.
    Lee HJ, Kim KS, Jeong JS, Cheong MA, Shim JC. Comparison of the adductor pollicis, orbicularis oculi, and corrugator supercilii as indicators of adequacy of muscle relaxation for tracheal intubation. Br J Anaesth. 2009;102(6):869–74.CrossRefPubMedGoogle Scholar
  56. 56.
    Sayson SC, Mongan PD. Onset of action of mivacurium chloride. A comparison of neuromuscular blockade monitoring at the adductor pollicis and the orbicularis oculi. Anesthesiology. 1994;81(1):35–42.CrossRefPubMedGoogle Scholar
  57. 57.
    Haller G, Gardaz JP, Bissonnette B. Assessment of intubation time and conditions under the influence of rocuronium. Can J Anaesth. 1998;45(4):312–6.CrossRefPubMedGoogle Scholar
  58. 58.
    Thilen SR, Hansen BE, Ramaiah R, Kent CD, Treggiari MM, Bhananker SM. Intraoperative neuromuscular monitoring site and residual paralysis. Anesthesiology. 2012;117(5):964–72.CrossRefPubMedGoogle Scholar
  59. 59.
    Larsen PB, Gatke MR, Fredensborg BB, Berg H, Engbaek J, Viby-Mogensen J. Acceleromyography of the orbicularis oculi muscle II: comparing the orbicularis oculi and adductor pollicis muscles. Acta Anaesthesiol Scand. 2002;46(9):1131–6.CrossRefPubMedGoogle Scholar
  60. 60.
    Engbaek J, et al. Clinical recovery and train-of-four ratio measured mechanically and electromyographically following atracurium. Anesthesiology. 1989;71(3):391–5.CrossRefPubMedGoogle Scholar
  61. 61.
    Engbaek J, et al. The agreement between adductor pollicis mechanomyogram and first dorsal interosseous electromyogram. A pharmacodynamic study of rocuronium and vecuronium. Acta Anaesthesiol Scand. 1994;38(8):869–78.CrossRefPubMedGoogle Scholar
  62. 62.
    Kopman AF. The relationship of evoked electromyographic and mechanical responses following atracurium in humans. Anesthesiology. 1985;63(2):208–11.CrossRefPubMedGoogle Scholar
  63. 63.
    Katz RL. Comparison of electrical and mechanical recording of spontaneous and evoked muscle activity. The clinical value of continuous recording as an aid to the rational use of muscle relaxants during anesthesia. Anesthesiology. 1965;26:204–11.CrossRefPubMedGoogle Scholar
  64. 64.
    Shanks CA, et al. Dose-response curves for four neuromuscular blockers using continuous i.v. infusion. Br J Anaesth. 1981;53(6):627–33.CrossRefPubMedGoogle Scholar
  65. 65.
    Harper NJ, Bradshaw EG, Healy TE. Evoked electromyographic and mechanical responses of the adductor pollicis compared during the onset of neuromuscular blockade by atracurium or alcuronium, and during antagonism by neostigmine. Br J Anaesth. 1986;58(11):1278–84.CrossRefPubMedGoogle Scholar
  66. 66.
    Weber S, Muravchick S. Electrical and mechanical train-of-four responses during depolarizing and nondepolarizing neuromuscular blockade. Anesth Analg. 1986;65(7):771-6.CrossRefPubMedGoogle Scholar
  67. 67.
    Carter JA, et al. Assessment of the Datex Relaxograph during anaesthesia and atracurium-induced neuromuscular blockade. Br J Anaesth. 1986;58(12):1447–52.CrossRefPubMedGoogle Scholar
  68. 68.
    Engbaek J. Monitoring of neuromuscular transmission by electromyography during anaesthesia. A comparison with mechanomyography in cat and man. Dan Med Bull. 1996;43(4):301–16.PubMedGoogle Scholar
  69. 69.
    Hanzi P, et al. Clinical validation of electromyography and acceleromyography as sensors for muscle relaxation. Eur J Anaesthesiol. 2007;24(10):882–8.CrossRefPubMedGoogle Scholar
  70. 70.
    Gatke MR, Larsen PB, Engbaek J, Fredensborg BB, Berg H, Viby-Mogensen J. Acceleromyography of the orbicularis oculi muscle I: significance of the electrode position. Acta Anaesthesiol Scand. 2002;46(9):1124–30.CrossRefPubMedGoogle Scholar
  71. 71.
    Soltesz S, Stark C, Noé KG, Anapolski M, Mencke T. Monitoring recovery from rocuronium-induced neuromuscular block using acceleromyography at the trapezius versus the adductor pollicis muscle: an observational trial. Can J Anaesth. 2016;63(6):709–17.CrossRefPubMedGoogle Scholar
  72. 72.
    Loan PB, et al. The TOF-Guard neuromuscular transmission monitor. A comparison with the Myograph 2000. Anaesthesia. 1995;50(8):699–702.CrossRefPubMedGoogle Scholar
  73. 73.
    Liang SS, Stewart PA, Phillips S. An ipsilateral comparison of acceleromyography and electromyography during recovery from nondepolarizing neuromuscular block under general anesthesia in humans. Anesth Analg. 2013;117(2):373–9.CrossRefPubMedGoogle Scholar
  74. 74.
    Kopman AF. Neuromuscular monitoring: old issues, new controversies. J Crit Care. 2009;24(1):11–20.CrossRefPubMedGoogle Scholar
  75. 75.
    Brull SJ, Silverman DG. Real time versus slow-motion train-of-four monitoring: a theory to explain the inaccuracy of visual assessment. Anesth Analg. 1995;80(3):548–51.PubMedGoogle Scholar
  76. 76.
    Fuchs-Buder T, Claudius C, Skovgaard LT, Eriksson LI, Mirakhur RK, Viby-Mogensen J, et al. Good clinical research practice in pharmacodynamic studies of neuromuscular blocking agents II: the Stockholm revision. Acta Anaesthesiol Scand. 2007;51(7):789–808.CrossRefPubMedGoogle Scholar
  77. 77.
    Claudius C, Skovgaard LT, Viby-Mogensen J. Is the performance of acceleromyography improved with preload and normalization? A comparison with mechanomyography. Anesthesiology. 2009;110(6):1261–70.CrossRefPubMedGoogle Scholar
  78. 78.
    Dubois PE, Broka SM, Jamart J, Joucken KL. TOF-tube, a new protection for acceleromyography, compared with the TOF-Guard/TOF-Watch arm board. Acta Anaesthesiol Belg. 2002;53(1):33–8.PubMedGoogle Scholar
  79. 79.
    • Naguib M, Brull SJ, Johnson KB. Conceptual and technical insights into the basis of neuromuscular monitoring. Anaesthesia. 2017;72(Suppl 1):16–37. A recent review on the practical aspects of neuromuscular monitoring. CrossRefPubMedGoogle Scholar
  80. 80.
    Jensen E, Viby-Mogensen J, Bang U. The Accelograph®: a new neuromuscular transmission monitor. Acta Anaesthesiol Scand. 1988;32(1):49–52.CrossRefPubMedGoogle Scholar
  81. 81.
    Kern SE, Johnson JO, Westenskow DR, Orr JA. An effectiveness study of a new piezoelectric sensor for train-of-four measurement. Anesth Analg. 1994;78(5):978–82.CrossRefPubMedGoogle Scholar
  82. 82.
    Dahaba AA, Rehak PH, List WF. Assessment of accelerography with the TOF-GUARD: a comparison with electromyography. Eur J Anaesthesiol. 1997;14(6):623–9.CrossRefPubMedGoogle Scholar
  83. 83.
    Dahaba AA, et al. The neuromuscular transmission module versus the relaxometer mechanomyograph for neuromuscular block monitoring. Anesth Analg. 2002;94(3):591–6. table of contentsCrossRefPubMedGoogle Scholar
  84. 84.
    Motamed C, Kirov K, Combes X, Duvaldestin P. Comparison between the Datex-Ohmeda M-NMT module and a force-displacement transducer for monitoring neuromuscular blockade. Eur J Anaesthesiol. 2003;20(6):467–9.CrossRefPubMedGoogle Scholar
  85. 85.
    Dahaba AA, von Klobucar F, Rehak PH, List WF. Comparison of a new piezoelectric train-of-four neuromuscular monitor, the ParaGraph, and the Relaxometer mechanomyograph. Br J Anaesth. 1999;82(5):780–2.CrossRefPubMedGoogle Scholar
  86. 86.
    Stewart PA, Freelander N, Liang S, Heller G, Phillips S. Comparison of electromyography and kinemyography during recovery from non-depolarising neuromuscular blockade. Anaesth Intensive Care. 2014;42(3):378–84.PubMedGoogle Scholar
  87. 87.
    Khandkar C, Liang S, Phillips S, Lee CY, Stewart PA. Comparison of kinemyography and electromyography during spontaneous recovery from non-depolarising neuromuscular blockade. Anaesth Intensive Care. 2016;44(6):745–51.PubMedGoogle Scholar
  88. 88.
    Dahaba AA, Bornemann H, Holst B, Wilfinger G, Metzler H. Comparison of a new neuromuscular transmission monitor compressomyograph with mechanomyograph. Br J Anaesth. 2008;100(3):344–50.CrossRefPubMedGoogle Scholar
  89. 89.
    Barry DT, Cole NM. Muscle sounds are emitted at the resonant frequencies of skeletal muscle. IEEE Trans Biomed Eng. 1990;37(5):525–31.CrossRefPubMedGoogle Scholar
  90. 90.
    Hemmerling TM, Michaud G, Trager G, Deschamps S. Phonomyographic measurements of neuromuscular blockade are similar to mechanomyography for hand muscles. Can J Anaesth. 2004;51(8):795–800.CrossRefPubMedGoogle Scholar
  91. 91.
    Hemmerling TM, Babin D, Donati F. Phonomyography as a novel method to determine neuromuscular blockade at the laryngeal adductor muscles: comparison with the cuff pressure method. Anesthesiology. 2003;98(2):359–63.CrossRefPubMedGoogle Scholar
  92. 92.
    Wehbe M, Arbeid E, Cyr S, Mathieu PA, Taddei R, Morse J, et al. A technical description of a novel pharmacological anesthesia robot. J Clin Monit Comput. 2014;28(1):27–34.CrossRefPubMedGoogle Scholar
  93. 93.
    Veiga Ruiz G, García Cayuela J, Orozco Montes J, Parreño Caparrós M, García Rojo B, Aguayo Albasini JL. Monitoring intraoperative neuromuscular blockade and blood pressure with one device (TOF-Cuff): a comparative study with mechanomyography and invasive blood pressure. Revista espanola de anestesiologia y reanimacion. 2017;64(10):560–7.CrossRefPubMedGoogle Scholar
  94. 94.
    Rodiera J, Serradell A, Alvarez-Gomez JA, Aliaga L. The cuff method: a pilot study of a new method of monitoring neuromuscular function. Acta Anaesthesiol Scand. 2005;49(10):1552–8.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Hajime Iwasaki
    • 1
  • Reka Nemes
    • 2
  • Sorin J. Brull
    • 2
  • J. Ross Renew
    • 2
  1. 1.Asahikawa Medical UniversityHokkaidoJapan
  2. 2.Mayo ClinicJacksonvilleUSA

Personalised recommendations