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In another set of 118 patients, the developed tool was validated (Fig.

After arrival to the operating room, standard monitoring was applied which included electrocardiography, pulse oximetry, automatic non-invasive blood-pressure measurement, oropharyngeal temperature and capnography.

Following 3 min of stabilization of the EMG recording, atracurium 0.5 mg/kg was intravenously injected and the trachea intubated.

Therefore, we will continue to see patients with residual neuromuscular block in the PACU.

Neuromuscular monitoring in awake patients has so far not been validated [].

Patients were anaesthetized with remifentanil and propofol and ventilated with 100% oxygen using a facemask.

Neuromuscular function was monitored according to international consensus guidelines, using evoked EMG of the adductor pollicis muscle with a NMT module in a S/5 GE Datex Light monitor (GE Datex Medical Instrumentation, Inc., Tewksbury, MA, USA) by a non-blinded investigator [].

Although these studies could demonstrate accordance between acceleromyography (AMG) and clinical signs of muscle weakness, there is no standard diagnostic tool for postoperative residual neuromuscular block [].

In this multicentre, prospective, double-blinded, assessor controlled study we developed and validated an algorithm of clinical muscle function tests to identify residual paralysis in awake patients after anaesthesia.

The algorithm has a discriminative power comparable to uncalibrated AMG within TOF-values Use of neuromuscular monitoring together with pharmacological reversal of neuromuscular blocking drugs in the operation room is able to reduce the incidence of residual paralysis in patients arriving in the postoperative care unit (PACU), especially when a quantitative monitoring device is used [].

Therefore, in everyday practice, anaesthesiologists often prefer simple peripheral nerve stimulators (PNS) to assess fading qualitatively.

Patients were excluded from the study if they currently participated in another study, if their body mass index was over 30, if age was under 18 or over 65 years, if they had a history of neuromuscular diseases or gastro-esophageal reflux disease.

A set of 200 patients served as data pool to develop the algorithm of clinical muscle function tests to identify residual neuromuscular block.

Following calibration, the ulnar nerve was stimulated with supramaximal train-of-four (TOF) stimulation at 20s intervals and the evoked electromyogram of the adductor pollicis muscle was recorded.

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