The ASA Guideline recommends Quantitative Train of Four or QTOF monitoring when administering a paralytic. The ASA Guideline indicates that you should only use Neostigmine when the patient has a TOF ration >40%. A QTOF monitor is required to know when you are >40% so Quantitative TOF monitoring is needed to continue using Neostigmine as directed.
The highlights of the study: “Quantitative Neuromuscular Monitoring in Clinical Practice: A Professional Practice Change Initiative”, Wade A. Weigel, M.D
Using Quantitative TOF monitoring results:
• Pulmonary complications reduced by 42%
• PACU time reduced by 7%
• Sugammadex dosage decreased by an average of 14%
• 7% increase in patients needing no reversal
The Weigel study also shows the need for Electomyography or EMG and Acceleromyography or AMG. The use of EMG in specific cases such as robotics and tucked arm cases can be accomplished with the availability of EMG for as few as 20% of procedures. You can save your facility $22 per EMG Electrode for up to 80% of your cases as AMG is virtually free with no expensive electrode required. If your facility does 10,000 general anesthetics having AMG capability for 80% of these cases will save you $176,000 per year! The Stimpod is the only Quantitative TOF monitor that has both AMG and EMG capability in the same device accessible simply by changing the cable.