Neuromuscular Monitoring in Modern Anesthetic Practice: A Narrative Review
Abstract: Neuromuscular blocking agents are integral to modern anesthesia, facilitating tracheal intubation, surgical exposure and controlled ventilation. However, incomplete recovery from neuromuscular blockade remains an important and preventable perioperative safety problem. Clinical assessment alone, including head lift, hand grip and respiratory pattern, is insufficiently sensitive to exclude clinically relevant residual weakness. The development of peripheral nerve stimulation and quantitative neuromuscular monitors has transformed assessment from subjective observation to objective measurement. Current recommendations favor quantitative monitoring, particularly at the adductor pollicis, and confirmation of a train-of-four ratio of at least 0.9 before extubation. This narrative review summarizes the physiology of neuromuscular transmission, principles of peripheral nerve stimulation, train-of-four monitoring, double-burst stimulation, tetanic stimulation and post-tetanic count. It also reviews qualitative versus quantitative monitoring, acceleromyography and electromyography, appropriate monitoring sites, interpretation of neuromuscular block depth, pharmacological reversal with sugammadex and neostigmine, and practical considerations for safe extubation. Special attention is given to residual neuromuscular blockade, common technical errors and the implementation of quantitative monitoring in routine anesthesia practice. Contemporary neuromuscular monitoring should be considered an integral component of safe anesthesia whenever neuromuscular blocking drugs are administered.
Keywords: Neuromuscular monitoring; train-of-four; TOF ratio; peripheral nerve stimulation; residual neuromuscular blockade; sugammadex; neostigmine; quantitative monitoring
How to Cite?: Kanabar Sonal Vijaybhai, "Neuromuscular Monitoring in Modern Anesthetic Practice: A Narrative Review", Volume 15 Issue 11, November 2026, International Journal of Science and Research (IJSR), Pages: 464-469, https://www.ijsr.net/getabstract.php?paperid=SR261112011736, DOI: https://dx.doi.org/10.21275/SR261112011736