Train of Four (TOF) Monitoring - Neuromuscular Blockade Used to titrate NMB to the minimum effective dose. • Muscles are are electrically stimulated 4 times in rapid succession & the number of contractions are noted. • After achieving adequate sedation, electrodes are applied and the nerve is stimulated using a low current (10-20 mA); the current is increased until 4 vigorous twitches are seen. Further increasing the current should not lead to more forceful contraction (supramaximal stimulation). • Once the supramaximal stimulation is documented, NMB is initiated • Titrate NMB according to the number of twitches seen at the prior current: decrease NMB infusion if fewer than goal twitches seen Excerpted from original infographic by Nick Mark MD @nickmmark #ToF #Train #Four #Monitoring #Neuromuscular #Blockade #NMB #neurology #criticalcare #diagnosis
