anaesthesia critical-care
Train-of-Four (TOF) Neuromuscular Monitoring
Interprets Train-of-Four ratio to assess depth of neuromuscular blockade and guide reversal of non-depolarising muscle relaxants.
Score interpretation
Profound neuromuscular block (0-1 twitches)
→ Continue blockade if required; do NOT attempt reversal; consider sugammadex if urgent reversal needed
Deep to moderate block (2-3 twitches)
→ Allow spontaneous recovery; sugammadex 4mg/kg for reversal; neostigmine not appropriate
Partial recovery (4 twitches, TOF < 0.9)
→ Sugammadex 2mg/kg or neostigmine + atropine; recheck TOF before extubation
Adequate recovery (TOF >= 0.9)
→ Safe to extubate; full neuromuscular recovery confirmed
Interpretation bands for the TOF / Neuromuscular Block. Apply clinical judgement and local guidance.
References
Related
Curated clinical cross-links plus same-class fallbacks.
Drugs
- Sugammadex · Selective Neuromuscular Blockade Reversal Agent
- Sugammadex · Neuromuscular Blockade Reversal
- Neostigmine · Acetylcholinesterase Inhibitor / Neuromuscular Blockade Reversal
- Neostigmine (with Glycopyrronium) · Anticholinesterase — Neuromuscular Blockade Reversal
- Neostigmine · Anticholinesterase (Reversal Agent)
- Cisatracurium · Neuromuscular Blocking Agent (Non-Depolarising)
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.