The purpose of this study is to assess the effect of quantitative block monitoring versus less expensive qualitative monitoring treatment effects on the lowest SpO2/FiO2 ratio in the PACU. The results will be incorporated into an enhanced recovery pathway for surgical patients.
Patient age ≥ 18 years old;
General anesthesia with endotracheal intubation;
Neuromuscular block with rocuronium.
Intubation before induction of anesthesia;
Critically ill patients admitted from the ICU;
Emergency cases;
Non-intubated patients;
Crossover
Quantitative monitoring
DeviceThe TetraGraph TOF monitor will be used to quantitatively assess the TOF-ratio. Quantitative monitoring includes objective measurement of the TOF-ratio, as defined by the ratio between the first and the fourth muscular responses and is quantified by acceleromyography. A TOF twitch response ratio equal or greater to 95% (TOF0.95) will be targeted prior to extubation. If TOF0.95 is not reached within 10 min of administering the initial dose of the respective reversal agent, redosing is recommended.
Qualitative monitoring
Other interventionClinicians will assess the TOF-ratio. Qualitative monitoring includes subjective assessment of the count and the amplitude of the muscular responses related to neuromuscular block depth. A TOF twitch response count of 4 similarly strong twitches will be targeted prior to extubation. If 4 similarly strong TOF twitch responses are not reached within 10 min of administering the initial dose of the respective reversal agent, redosing is recommended.
lowest SpO2/FiO2 ratio in the PACU (constant for at least 10 minutes)
Collapsed composite (any vs none) of postoperative pulmonary complications
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