A short review of history and technical advances in quantitative neuromuscular monitoring devices

Abstract

Anesthetic procedures using a neuromuscular blocking drug (NMBD) always have a potential risk of residual neuromuscular block (RNMB) associated with serious respiratory complications despite the use of reversal agents. Due to the risk of RNMB, neuromuscular monitoring is a very important tool for assessing patient safety. Recently, the importance of quantitative neuromuscular monitoring has been highlighted because of the advent of sugammadex, which determines dosage based on the degree of NMB. Neuromuscular monitoring, which has been used clinically since the 1970s, is an appropriate method for assessing the level of neuromuscular blockade (NMB) after the use of a NMBD during anesthesia. Although the basic principles have not changed considerably, recent technical advances in neuromuscular monitoring devices can help anesthesiologists with convenient quantitative neuromuscular monitoring to accurately evaluate the levels of NMB, choose an appropriate NMBD, and avoid RNMB. The recently released electromyography-based devices provide more accurate values than acceleromyography (AMG). Although AMG has a problem with overestimation, modern AMG devices with new three-dimensional technology overcome this limitation. Anesthesiologists should increase their knowledge of neuromuscular mechanisms and monitoring, including how to use the latest device for proper neuromuscular monitoring and patient safety. In this review, we have explored the short history of neuromuscular monitoring devices and the latest trends in technology development.