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recovery does not occur until train-of-four ratio at the adductor pollicis is >0.9.
However, residual paralysis is still a problem, nearly 30 years after if was first described (Table 20-1), and in spite of the availability of shorter-acting neuromuscular blocking drugs and widespread use of neuromuscular monitoring.9 Part of this might be related to the recognition that the threshold for complete neuromuscular recovery is a train-of-four ratio of 0.9, instead of the traditional 0.7 (Fig. 20-4).132 Thus, an understanding of the pharmacology of neuromuscular blocking agents and reversal drugs is essential.
When given vecuronium, swallowing was impaired and laryngeal aspiration occurred when the train-of-four ratio was ≤0.9.132 These problems are difficult to diagnose when a tracheal tube is in place.
This maneuver correlated with a train-of-four ratio measured at the
Pressure measurements in the upper esophagus have been shown to be decreased (Fig. 20-4) and laryngeal aspiration detected at a train-of-four ratio <0.9.132 Thus, it appears that a normal head lift or leg lift is insufficient to guarantee normal upper airway function.
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