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FMGE 2022 — Anesthesiology

Q: Which of the following is the best method to assess the degree of muscle relaxation?

Train of four. ***Train of four*** - **Train of four (TOF)** is the most common and reliable method for monitoring the depth of neuromuscular blockade. - It involves delivering four sequential supramaximal electrical stimuli to a peripheral nerve, typically the ulnar nerve, and measuring the resulting muscle twitches. The **TOF ratio** (amplitude of the fourth twitch divided by the first) indicates the degree of relaxation. *Electromyography* - **Electromyography (EMG)** measures the electrical activity of muscles at rest and during contraction, which is useful for diagnosing neuromuscular disorders. - While it measures muscle activity, it is not optimized for continuous, real-time assessment of drug-induced neuromuscular blockade during surgery. *Tetanic Stimulation* - **Tetanic stimulation** involves delivering a high-frequency, continuous electrical stimulus to a peripheral nerve, producing sustained muscle contraction (tetanus). - It is used to assess profound neuromuscular blockade but is less practical for routine monitoring of relaxation depth as it can cause patient discomfort and post-tetanic facilitation, making it less precise for quantifying recovery. *Double burst stimulation* - **Double burst stimulation (DBS)** applies two short bursts of electrical stimuli, separated by a brief interval, and is used to detect residual blockade when the TOF ratio is difficult to assess visually. - While useful for detecting slight residual paralysis, it is not the primary or best method for assessing the *degree* of blockade throughout its entire duration, as it primarily confirms effective recovery rather than quantifying the entire spectrum of relaxation. [Practice more Anesthesiology PYQs on OnCourse]

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Which of the following is the best method to assess the degree of muscle relaxation?