Neurophysiological Assessment of Prolonged Recovery From Neuromuscular Blockade in the Neonatal Intensive Care Unit

Omri David Soffer, Angela Kim, Ellen Underwood, Anne Hansen, Laura Cornelissen, Charles Berde

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Objective: To evaluate recovery from neuromuscular blockade in infants using Train-of-Four nerve stimulation. Study Design: Ulnar nerve stimulation was used to evoke thumb twitch and reported as Train-of-Four ratio. Thumb twitch was also recorded visually in real-time. Primary outcome was time to near recovery of muscle function (Train-of-Four ratio >70%). Secondary analyses were time to greater degrees of recovery (Train-of-Four ratio >80, 90%), sensitivity of accelerometry vs. visual thumb-twitch and clinical variates to assess safety. Results: Patients were enrolled following rocuronium-boluses (n = 10) and vecuronium-infusions (n = 9). Median recovery time to Train-of-Four ratio >70% was 14 h following rocuronium-bolus dosing and 34 h following cessation of continuous vecuronium infusion. Median stimulus threshold for accelerometry was 27.5 mA and visual observation was 20 mA. There were no safety concerns. Conclusion(s): Neuromuscular monitoring using Train-of-Four nerve stimulation is feasible in infants. Some infants exhibited prolonged recovery from neuromuscular-blockade. These pilot data may facilitate future standardized pediatric protocols on neuromuscular monitoring for safer dosing.

Original languageEnglish (US)
Article number580
JournalFrontiers in Pediatrics
StatePublished - Sep 18 2020
Externally publishedYes


  • children
  • infant
  • neonate
  • neuromuscular relaxants
  • rocuronium
  • train-of-four (TOF)
  • vecuronium

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health


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