Neuromuscular Blockade Reversal Guide

TwitchView Reversal Guide

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As demonstrated by Thilen et. al, quantitative neuromuscular monitoring with TwitchView allows clinicians to individualize dosing of rocuronium, determine the optimal reversal strategy and confirm complete antagonism of neuromuscular blockadepreventing post-operative residual neuromuscular blockade (PRNMB) [1].

TwitchView TOF Monitor Hero

The Benefits of TwitchView

In a study performed at Harborview Medical Center, clinicians utilized TwitchView, an EMG based quantitative neuromuscular monitor and a protocol to guide management and reversal of neuromuscular blockade, resulting in a 0% incidence rate of residual paralysis or PRNMB. Sugammadex was utilized in 48% of all patients and 17% of the patients in the mixed surgical population achieved adequate spontaneous recovery and did not need any pharmacological reversal.


Of note, Thilen et al. achieved this groundbreaking advance in patient safety while maintaining a role for neostigmine as a reversal strategy, resulting in pharmacologic cost savings of $42 per patient [1].


Patient Safety

"Using TwitchView and a protocol, we completely prevented post-operative residual neuromuscular blockade (PRNMB)."


Drug Spending

"The acquisition cost for reversal drugs would have been 70% higher if sugammadex had been used in all patients."

Three unique TwitchView features enable the precise management and appropriate antagonism of neuromuscular blockade.


Validated Accurate Data

Sensitive detection of twitches from profound blockade via post-tetanic count (PTC), to moderate blockade and recovery via TOF Count and TOF Ratio [2, 3].

TwitchView EMG TOFR 100%


Automatic Continuous Data

An AutoPTCTM feature that switches automatically between TOF and PTC stimulation modes based on the patient’s real-time level of blockade.

TwitchView Auto-PTC


Real-Time & Trended Data

An interactive, dynamic trend plot that enables clinicians to visualize how neuromuscular blocking agents affect each patient differently.

TwitchView Trend Plot TOFC 2

Hospitals are Already Benefitting from TwitchView.

We understand that new technology adoption requires planning, collaboration and education. Blink DC will partner with your institution to ensure effective use. 


References: 1. Thilen, Stephan R. MD, MS*; Sherpa, James R. MD†; James, Adrienne M. BS*; Cain, Kevin C. PhD‡; Treggiari, Miriam M. MD, MPH, PhD§; Bhananker, Sanjay M. MBBS, MD, FRCA*. Management of Muscle Relaxation With Rocuronium and Reversal With Neostigmine or Sugammadex Guided by Quantitative Neuromuscular Monitoring. Anesthesia & Analgesia ():10.1213/ANE.0000000000006511, May 12, 2023. | DOI: 10.1213/ANE.0000000000006511. 2. Bowdle A, Bussey L, Michaelsen K. Counting train-of-four twitch response: comparison of palpation to mechanomyography, acceleromyography, and electromyography. Br J Anaesth. 2020;124(6):712-717. 3. Bowdle A, Bussey L, Michaelsen K, et al. A comparison of a prototype electromyograph vs. a mechanomyograph and an acceleromygraph for assessment of neuromuscular blockade. Anesthesia. 2020;75(2):187-195.