The Role of Quantitative Twist Monitoring in Reversal of Neuromuscular Blockade

We typically administer too much Sugamadex, but not infrequently we don't give enough. Two patients had recurrent neuromuscular blockade despite successful reversal to a train of four ratio of 0.9. The degree of reparalysis was not severe, but is certainly nevertheless of concern. We studied only rockuronium, and this may turn out to be an important caveat. Vecuronium is not as avidly bound as SugamadeX as rock uranium; it may behave slightly differently.