PRACTICE PARAMETERABSTRACT2023 American SocietyThese practice guidelines provide evidence-based recommendations on themanagement of neuromuscular monitoring and antagonism of neuromuscularof Anesthesiologistsblocking agents during and after general anesthesia.The guidance focusesprimarily on the type and site of monitoring and the process of antagonizingPractice Guidelinesneuromuscular blockade to reduce residual neuromuscular blockade.for MonitoringANESTHESI0L06Y2023:138:13-41)and AntagonismHIGHLIGHTS BOXof Neuromuscular.This practice guideline provides evidence-based recommendationson the management of neuromuscular monitoring and antagonism ofBlockade:A Report byneuromuscular blocking agents.The objective is to guide practice thatwill enhance patient safety by reducing residual neuromuscular block-the American Society ofade.It is recommended to use quantitative neuromuscular monitoringat the adductor pollicis and to confirm a recovery of train-of-four ratioAnesthesiologists Taskgreater than or equal to 0.9 before extubation.Sugammadex is rec-ommended from deep,moderate,and shallow levels of neuromuscularForce on Neuromuscularblockade that is induced by rocuronium or vecuronium.Neostigmine isa reasonable altemative from minimal blockade (train-of-four ratio inBlockadethe range of 0.4 to less than 0.9).Patients with adequate spontaneousrecovery to train-of-four ratio greater than or equal to 0.9 can be iden-Stephan R.Thilen,M.D.,M.S.(co-chair),tified with quantitative monitoring,and these patients do not requireWade A.Weigel,M.D.(co-chair),Michael M.Todd,M.D..phamacological antagonism.Richard P.Dutton,M.D.,M.B.A.,Cynthia A.Lien,M.D.,Stuart A.Grant,M.D.,133to revision as warranted by the evolution of medical knowledge,Joseph W.Szokol,M.D.,J.D.,M.B.A.,FASA,technology,and practice.They provide basic recommendations134683Lars I.Eriksson,M.D.,Ph.D.,FRCA,for anesthesia care that are supported by synthesis and analysisMyron Yaster,M.D.,Mark D.Grant,M.D.,Ph.D.,of the current literature,expert and practitioner opinion,publicMadhulika Agarkar,M.P.H.,Anne M.Marbella,M.S.,comment,and clinical feasibility data.Practice guidelines aim toJaime F.Blanck,M.L.I.S.,M.P.A.,202201000improve patient care and patient outcomes by providing up-to-Karen B.Domino,M.D.,M.P.H.date information for patient care.ANESTHES10L0GY2023:138:13-41Purposeractice guidelines are systematically developed recommen-This practice guideline provides evidence-based recom-dations that assist the practitioner and patient in makingmendations regarding the appropriate management of neu-decisions about health care.These recommendations may beromuscular monitoring and antagonism of neuromuscularadopted,modified,or rejected according to dinical needs andblocking drugs during and after general anesthesia.The13A012003constraints and are not intended to replace local institutionalguidance focuses primarily on the process of antagonizingpolicies.In addition,practice guidelines developed by theneuromuscu
