What is TOF monitoring?

TOF pattern was developed for assessing neuromuscular block in the anesthetized patient. TOF was developed as a stimulation pattern that did not require a comparison to a control response before administration of a neuromuscular blocking agent.

How often do you check train of four?

If patient remains at the TOF goal and clinical goal, assess TO4 at least every 4 hours while on continuous NMBA.

How do you check on a train of 4?

Turn on the peripheral nerve stimulator and select a low amplitude, usually 10 or 20 mA to start. Increase the current in increments of 10 mA until 4 twitches are observed. Note the current (in mA) that corresponds to 4 vigorous twitches when the train-of-four stimuli button is pushed.

Where should TOF electrodes be placed?

The optimal placement of the electrodes is the ulnar nerve. However, the conduction of the impulses is affected by wounds, edema and invasive lines, and hair, therefore, if any of these are present the facial nerve or the posterior tibial nerve should be used instead.

What is TOF ratio?

TOF Count is the number of detected muscle responses. Train- of-four ratio (TOF%) is the ratio of the fourth muscle response to the first one. TOF% indicates fade in non-depolarizing block. Once the TOF Count drops below four responses or T1% is less than 10%, the TOF% cannot be calculated.

Where do you put TOF leads?

Apply the two electrodes either at the ulnar nerve area, the facial nerve area or the posterior tibial nerve area. (Please see pictures below to verify proper placement.) The optimal placement of the electrodes is the ulnar nerve.

When do you give neostigmine TOF?

Ideally, neostigmine should not be administered until at least the fourth response to TOF stimulation appears; however, the time to achieve acceptable neuromuscular recovery may be as much as 15 min in this setting, even after a large dose (0.06 to 0.07 mg/kg) of neostigmine.

What is a good TOF?

Achieving TOF-ratio above 0.9 is considered an adequate sign of recovery from the effect of non-depolarizing muscle relaxants [52].

What does NMT measure?

How is the NMT block measured? The level of neuromuscular block is routinely measured by stimulating a peripheral nerve, usually in the hand and by subjectively evaluating the muscle response either visually or tactilely with a device.

What should train of four be?

Stimulation current was 20-30 mA for hand and 30-60mA foot TOF by a group of 0.2 millisecond pulses, spaced 500 millisecond apart, to deliver four contractions.

Can you reverse cisatracurium with neostigmine?

And neostigmine 10, 20, or 40 ㎍/kg will injected in each arms. At anesthetic induction, rocuronium 0.6 mg/kg will be injected for muscle relaxation….Appropriate Dose of Neostigmine for Reversal of Rocuronium and Cisatracurium.

Study Type : Interventional (Clinical Trial)
Actual Enrollment : 112 participants