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Clinical tests are worthless in predicting objective neuromuscular recovery: A-127

De Jongh, K.; Cammu, G.; Vandeput, D.; Vandenbroucke, G.; Mortier, E.

European Journal of Anaesthesiology: May 2005 - Volume 22 - Issue - p 35
Ambulatory Anaesthesia

Department of Anaesthetics, OLV Clinic, Aalst, Belgium

Background and goal: To assess if clinical tests are good predictors of objective neuromuscular recovery as registered by the train-of-four (TOF) ratio.

Materials and methods: In 630 patients, the TOF ratio was measured and 8 clinical tests were performed at arrival in the recovery room. The patients had all received a single bolus of neuromuscular blocking drug (NMBD) at induction. The choice and dosage of NMBD had been at the anaesthetist's discretion. The clinical tests were: ability to smile (A), ability to swallow (B), ability to speak (C), appearance of general weakness (D), sustained head lift for 5s (E), leg lift (F), hand grip (G) and sustained tongue depressor test (H).

Results:Table 1 shows the relation between the TOF and the number of positively scored clinical tests. Table 2 shows the best combination of tests for each positive score between 1 and 8 (Pearson and Spearman correlations).

Table 1

Table 1

Table 2

Table 2

Of the patients with a good score in all the clinical tests, 12% still belonged to the category of ‘clinically dangerous’, while among those with a bad score, 58% had an ‘ideal’ TOF ratio (Table 1). The correlations were low (Table 2), so none of the combinations of clinical tests were good predictors.

Conclusion: The clinical tests considered here are not good predictors of objective neuromuscular recovery as measured by the TOF ratio.

© 2005 European Society of Anaesthesiology