Twitch, Tetanus and Train-of-Four as Indices of Recovery from Nondepolarizing Neuromuscular Blockade

Correlation between integrated evoked EMG and respiratory function following atracurium administration in unanaesthetized humans

“…A sustained twitch response to tetanic stimulation at 50 Hz is a good indicator for adequate return of neuromuscular transmission, and, therefore, respiratory function. ~, 25 However, tetanic stimulation is painful and, therefore, not applicable to awake patients. The introduction of train-of-four stimulation, which is relatively pain-free, and the subsequent demonstration of its correlation with single twitch response s has made such monitoring a standard practice.…”

Residual Neuromuscular Blockade: A Persistent Clinical Problem

“…2), a pattern of 4 stimuli at 2 Hz is repeated every 10 to 12 seconds. 7 With TOF, a comparison of the strength of the first twitch (T 1 ) 2 seconds later with that of the fourth twitch (T 4 ) eliminates the need for a control value. On the basis of comparisons with single twitch stimuli, 1, 2, or 3 twitches will be elicited when the strength of the first twitch is reduced to 90%, 80%, and 75% of the control height, respectively.…”

General anesthesia for electroconvulsive therapy with Brugada electrocardiograph pattern

“…Electrocardiography, blood pressure, pulse oximetry, body temperature and neuromuscular transmission at the adductor pollicis muscle using acceleromyography or train of four (TOF) were monitored. The number of responses to the TOF stimuli indicates the degree of neuromuscular blockade (10). Four twitches (T4) of the TOF response mean to be able to move, three twitches (T3) indicate intermediate acting muscle relaxant, two twitches (T2) are suitable for short term relaxation with approximate 80% of receptors blocked, and one twitch (T1) and twitches absent (T0) of the TOF are conditions for intubation or long term mechanical ventilation.…”