Current Status of Neuromuscular Reversal and Monitoring: Posttetanic Neuromonitoring and Other Considerations
Notice bibliographique
Résumé
The recent comprehensive review article by Drs. Brull and Kopman1 outlines the challenges and opportunities of the current status of neuromuscular reversal and monitoring. Their superlative and informative review is clearly destined to be a go-to reference on the subject. Importantly, it should serve as a rallying point for advancing future neuromuscular blockade (NMB) and function monitoring.Several aspects of this article do warrant additional comment, however. First, the article deals with many important concepts in NMB monitoring and reversal, including not only perioperative considerations, but issues pertinent to the intensive care unit (ICU) where residual neuromuscular blockade, and associated patient awareness, has occasionally been reported.2 Given that the article will rightly take its place as a definitive article on the subject, and as an advocate for postpublication peer-review, I was curious as to why the section discussing awareness from residual paralysis in the ICU included a reference to an article on hypothermia in the ICU (that does not actually mention awareness at all).3 That minor irregularity aside, the excellent text, tables, and figures make for an easy to understand description of all the important concepts in NMB monitoring.A second issue that was particularly interesting was in the discussion of posttetanic count (PTC) as it pertains to posttetanic facilitation. Although the important information the authors provided was accurate, it incompletely addressed an often-misunderstood PTC concept—that is, the time period following a tetanic stimulus that the neuromuscular junction is affected and that subsequent train-of-four (TOF) monitoring might be impaired. Indeed, Hakim et al.4 recently dispelled the common misconception that PTC impairs the NMB for a protracted period of time, showing that TOF responses are reliable as early as one minute after a PTC. I think it is worthwhile bringing this to the readers’ attention, particularly in a definitive and comprehensive article.Lastly, both Brull and Kopman, as well as the accompanying editorial by Naguib and Johnson,5 highlight the importance of moving forward the “state of the art” of NMB monitoring. Importantly, the editorial highlights the American Society of Anesthesiologists’ significant gap in providing guidance on neuromuscular blockade monitoring, particularly when compared with other similar anesthesia societies.6,7 Articles such as this one from Brull and Kopman will, we can hope, encourage the American Society of Anesthesiologists to take a more progressive stance on the subject and advocate for the use of NMB monitoring whenever neuromuscular blocking drugs are used.The author declares no competing interests.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».