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Comparative Study of TOF-Cuff, a New Neuromuscular Blockade Monitor, and TOF-Watch, an Acceleromyography

Kazuma, Satoshi MD, PhD; Wakasugi, Keiko MD; Hagiwara, Hiroya MD; Yamakage, Michiaki MD, PhD

doi: 10.1213/ANE.0000000000004147
Technology, Computing, and Simulation

Train-of-four ratios were recorded to assess the agreement between the TOF-Cuff and TOF-Watch, and residual paresis was assessed to evaluate the clinical utility of TOF-Cuff. Train-of-four ratios were evaluated using Lin concordance correlation coefficient and Bland–Altman analyses. Measured train-of-four ratios demonstrated high accuracy and precision over the entire range of train-of-four ratios. Although precision and Lin concordance correlation coefficients decreased with train-of-four ratios >0.7, none of the patients showed signs of residual paresis. Because TOF-Cuff underestimated train-of-four ratios in the recovery period, the clinical safety of train-of-four ratios >0.9 indicated by TOF-Cuff is unclear; the issue of residual paresis requires future research that rigorously evaluates outcomes.

From the Department of Anesthesiology, Sapporo Medical University School of Medicine, Hokkaido, Japan.

Published ahead of print 21 February 2019.

Accepted for publication February 21, 2019.

Funding: None.

The authors declare no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website.

Clinical trial number and registry URL: R000028727 and

Reprints will not be available from the authors.

Address correspondence to Satoshi Kazuma, MD, PhD, Department of Anesthesiology, Sapporo Medical University School of Medicine, S 1 W 16, Chuo-ku, Sapporo, Hokkaido 060-8543, Japan. Address e-mail to

Copyright © 2019 International Anesthesia Research Society
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