Facility Information:

Input your facility-specific drug costs or use our default values

Source:

Farhan H, Moreno-Duarte I, McLean D, Eikermann M. Residual Paralysis: Does it Influence Outcome After Ambulatory Surgery? Current Anesthesiology Reports. 2014;4(4):290-302.

Current Practice Information:

Current practice represents the standard at many hospitals and assumes the use of a peripheral nerve stimulator (qualitative monitor) with timing and dose of neostigmine or sugammadex reversal at the discretion of the anesthesia provider.

Source:

Thilen, S.R. & Ng, I.C. & Cain, K.C. & Treggiari, M.M. & Bhananker, S.M. Management of rocuronium neuromuscular block using a protocol for qualitative monitoring and reversal with neostigmine. British Journal of Anaesthesia. 2018; 121(2):367-377

Target Practice (with TwitchView ®) Information:

Target practice uses quantitative monitor and reduces risk factors for residual paralysis while minimizing costs associated with overuse of drugs.

Rocuronium dosing based on level of paralysis

Dosing of rocuronium is often based on time since last dose or when the surgeon requests additional relaxation. With continuous quantitative train-of-four data, rocuronium can be dosed to achieve a specific level of paralysis. When TwitchView®, a rapid practice modification is a significant decrease in the intubating dose of rocuronium as well as less frequent and smaller redosing.

Conservative reversal

With less rocuronium, patients tend to have shallower block at the end of the case, allowing for lower doses of sugammadex, the use of neostigmine instead of sugammadex, or spontaneous recovery. Importantly, adequacy of reversal is confirmed by TOF ratio > 90% prior to extubation, which eliminates the possibility of residual paralysis.

Sources:

Thilen SR, et al. Best Management of Muscle Relaxation with Rocuronium Using Objective Monitoring and Reversal with Neostigmine or Sugammadex. Oral presentation Feb 28, 2020, Whistler Anesthesia Summit, Whistler, BC, Canada.

Lori-Ann M. Edwards, et al. Universal Quantitative Neuromuscular Blockade Monitoring at an Academic Medical Center- A Multimodal Analysis of the Potential Impact on Clinical Outcomes and Total Cost of Care. Perioperative Care and Operating Room Management. 2021;24: 24. 100184.