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. Sug. 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]