Sugammadex after the reappearance of four twitches during train-of-four stimulation: Monitoring and dose considerations

摘要

I read with great interest the article by Pongracz et al. evaluating the appropriate dose of sugammadex to reverse neu-romuscular blockade (NMB) after the reappearance of four twitches during train-of-fbur (TOF) stimulation. It is a welcome addition to previous studies that have demonstrated the superiority of sugammadex over anticholinesterases in completely, safely, and quickly reversing rocuronium-induced NMB of any magnitude.This study raises two important issues, which deserve comment.To my knowledge, this is the first clinical trial that has considered a TOF ratio of 1.0, instead of 0.9 or greater, as the goal for reversal of NMB.A TOF ratio of 0.9 or greater may not indicate full recovery, as this ratio can be associated with impaired neuromuscular transmission, inhibition of the hypoxic-ventilatory response, and upper airway or pharyn-geal dysfunction.