Saager et al evaluated patients for residual neuromuscular block after surgery. The presence of residual neuromuscular blockade can negatively affect postoperative recovery. The authors are from multiple institutions in the United States and Canada.

Patient selection: general anesthesia with neuromuscular block (non-depolarizing), ASA 1 to 3


Patient evaluation: Train of Four (TOF)

Criteria for residual neuromuscular blockade: TOF ratio (T4 to T1) < 0.9 at tracheal extubation



(1) male sex (OR 2.6)

(2) obesity by body mass index (OR 1.04 per unit), with BMI >= 30 kg per sq meter at greater risk

(3) surgery at a community hospital (OR 3.2)

(4) ASA 3


Residual neuromuscular blockade was noted in patients despite neostigmine reversal, so this group should not be exempt from monitoring.

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