By Bahaa Ewees Professor of anaesthesia and intensive care medicine

* Why? * How? * Where?

A. Monitoring the onset time of action B. Monitoring the duration of action C. Monitoring of recovery

Methods 1. Electrical  EMG  TOF (?) 2. Mechanical 3. Acceleration

Electrical Single Twitch TOF

 T 1, T 2, T 3, T 4 …  Complete Relaxation Time  T 1  0 – 9 %

Muscle Relaxant of Different Duration Time of Action (HOW?)

 T 1  9 %  T 1  25 %  T 1  3 % (???)  just reappearance of T 1

Recovery  Tetanic Stimulation  Post Tetanic Count  Post Tetanic Facilitation  Post Tetanic TOF  Double Burst Stimulation (DBS)  DBS  D 2 B 2 S  D 3 B 3 S

Acceleromyography  WHERE?

 Ulnar N.  Facial N.  Common Peroneal N.

 Adductor Pollicis (WHY?)

When To Give Reversal??

 Half-reverse and Full reverse  What is the meaning??  1 st Dose followed by 2 nd Dose (3 min. in between)

Conclusion  TR equals T 4 /T 1 is the conclusion in recovery  TR 75 %  TR 85 %  TR 98 %

* Why? * How? * Where?

A. Monitoring the onset time of action B. Monitoring the duration of action C. Monitoring of recovery

Thank You!!!