title: Intraoperative acceleromyography monitoring reduces symptoms of muscle weakness and improves quality of recovery in the early postoperative period.
abstract: BACKGROUND
  The subjective experience of residual neuromuscular blockade after emergence from anesthesia has not been examined systematically during postanesthesia care unit (PACU) stays. The authors hypothesized that acceleromyography monitoring would diminish unpleasant symptoms of residual paresis during recovery from anesthesia by reducing the percentage of patients with train-of-four ratios less than 0.9.
  
  
  METHODS
  One hundred fifty-five patients were randomized to receive intraoperative acceleromyography monitoring (acceleromyography group) or conventional qualitative train-of-four monitoring (control group). Neuromuscular management was standardized, and extubation was performed when defined criteria were achieved. Immediately upon a patient's arrival to the PACU, the patient's train-of-four ratios were measured using acceleromyography, and a standardized examination was used to assess 16 symptoms and 11 signs of residual paresis. This examination was repeated 20, 40, and 60 min after PACU admission.
  
  
  RESULTS
  The incidence of residual blockade (train-of-four ratios less than 0.9) was reduced in the acceleromyography group (14.5% vs. 50.0% control group, with the 99% confidence interval for this 35.5% difference being 16.4-52.6%, P < 0.0001). Generalized linear models revealed the acceleromyography group had less overall weakness (graded on a 0-10 scale) and fewer symptoms of muscle weakness across all time points (P < 0.0001 for both analyses), but the number of signs of muscle weakness was small from the time of arrival in the PACU and did not differ between the groups at any time.
  
  
  CONCLUSIONS
  Acceleromyography monitoring reduces the incidence of residual blockade and associated unpleasant symptoms of muscle weakness in the PACU and improves the overall quality of recovery.
authors.affiliation: Department of Anesthesiology, NorthShore University HealthSystem, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA.
authors.forename: Glenn S
authors.initials: GS
authors.lastname: Murphy
authors.forename: Joseph W
authors.initials: JW
authors.lastname: Szokol
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Avram
authors.forename: Steven B
authors.initials: SB
authors.lastname: Greenberg
authors.forename: Jesse H
authors.initials: JH
authors.lastname: Marymont
authors.forename: Jeffery S
authors.initials: JS
authors.lastname: Vender
authors.forename: Jayla
authors.initials: J
authors.lastname: Gray
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Landry
authors.forename: Dhanesh K
authors.initials: DK
authors.lastname: Gupta
mesh_terms: D000328:Adult; D000368:Aged; D000762:Anesthesia Recovery Period; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D018908:Muscle Weakness / Q000175:diagnosis / Q000517:prevention & control*; D009213:Myography / Q000379:methods*; D019148:Neuromuscular Blockade; D011184:Postoperative Period; D012372:ROC Curve