Choice of muscle relaxant dependent on duration, route of
metabolism, hemodynamic side effects (table 4).
- Monitoring: train-of-four (TOF)^ [13,25,26]
It is recommended that the degree of neuromuscular blockade
should be monitored during administration of a continuous
infusion. There is a lack of data in the literature to support a
standardized method, however the adult critical care practice
guidelines recommends both clinical assessment and TOF
monitoring for all patients on continuous infusions of
neuromuscular blockade, with the goal of adjusting the degree of
neuromuscular blockade to obtain 1 or 2 twitches on TOF [25].
There are no specific practice guidelines in the United States for
children, however consensus guildelines published in the United
Kingdom for neuromuscular blockade in children recommended
TOF monitoring at least once every 24 hours in children receiving
continuous infusions [26].^
Peripheral nerve stimulator placed over ulnar nerve and
impulse is generated
Twitch response of adductor pollicis and flexor digitorum
correlates to presence or absence of neuromuscular blockade
