Anaes Vivas · Neuromuscular blockade & reversal
Data viva — the train-of-four trace
A data viva on the train-of-four trace — the fade of the non-depolarising block (T4 < T1), the interpretation of the ratio, the deep block with absent twitches, and the 0.9 recovery target. Anchored to the Naguib monitoring consensus.
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Target exams
ANZCAFRCAABAEDAIC
Prompt
An acceleromyographic train-of-four trace showing four twitches of progressively diminishing amplitude (a T4/T1 ratio of approximately 0.4), followed by a later trace at full recovery (T4/T1 of 1.0).
Stimulus
An acceleromyographic trace from the adductor pollicis. A train-of-four shows four twitches of progressively diminishing height, with the fourth about 40 per cent of the first (a T4/T1 ratio of roughly 0.4). A later trace shows four equal twitches (a ratio of 1.0).[6]
References2ShowHide
- [5]Naguib M, Brull SJ, Kopman AF, Hunter JM, et al. Consensus Statement on Perioperative Use of Neuromuscular Monitoring. Anesthesia & Analgesia, 2018.PMID 29200077
- [6]Bersten AD, Soni N (eds) Oh's Intensive Care Manual. 8th edition, Elsevier, 2018.