{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T09:09:32Z","timestamp":1788858572047,"version":"build-2803163510"},"reference-count":21,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T00:00:00Z","timestamp":1779148800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T00:00:00Z","timestamp":1779148800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Anesthesia"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Objective neuromuscular monitoring is essential to prevent residual neuromuscular block in patients receiving neuromuscular blocking agents. However, the small size of pediatric hands and the lack of appropriately sized neuromuscular equipment have made quantitative neuromuscular monitoring at the ulnar nerve (UN) difficult. In such cases, the tibial nerve (TN) can serve as an alternative site. This study aimed to compare train\u2010of\u2010four (TOF) monitoring using acceleromyography (AMG) and electromyography (EMG) at the TN and UN in children aged 3\u201324\u2009months. We hypothesized that the time to reach a train\u2010of\u2010four ratio (TOFR) \u2265\u20090.9 would be shorter with AMG compared to EMG.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this observational study, a total of 107 pediatric patients scheduled to elective surgery under general anesthesia with rocuronium 0.6\u2009mg\/kg were included. Patients were allocated to either bilateral tibial nerve (TN) or bilateral ulnar nerve (UN) monitoring using AMG and EMG. The primary outcome was time to TOFR \u2265\u20090.9. Other outcomes were time to TOFC\u2009=\u20090 (onset); reappearance of post tetanic count (PTC)\u2009=\u20091, TOFC\u2009=\u20091, TOFC\u2009=\u20092, and symptoms of residual neuromuscular block.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Fifty patients were bilaterally monitored at TN and 50 patients were bilaterally monitored at UN. At TN time to TOFR \u2265\u20090.9 was 81\u2009min (SD 29) with AMG and 112\u2009min (SD 34) with EMG with a mean difference of 34\u2009min (95% CI: 29\u201339;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001). At UN time to TOFR \u2265\u20090.9 was 71\u2009min (SD 29) with AMG and 82\u2009min (SD 28) with EMG, with a mean difference of 11\u2009min (95% CI: 6\u201315;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001). Seventeen patients exhibited symptoms of residual neuromuscular block.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Time to TOFR \u2265\u20090.9 after rocuronium 0.6\u2009mg\/kg in children aged 3\u201324\u2009months was significantly shorter with AMG compared to EMG at both the UN and TN. AMG may underestimate the duration of action.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>ClinicalTrials.gov identifier: NCT06409260<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pan.70220","type":"journal-article","created":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T14:00:02Z","timestamp":1779199202000},"page":"1231-1237","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Neuromuscular Monitoring of Rocuronium 0.6\u2009mg\/kg in Children Aged 3\u201324\u2009Months With Electromyography and Acceleromyography: An Observational Study"],"prefix":"10.1002","volume":"36","author":[{"given":"Sarah Sofie","family":"Wadland","sequence":"first","affiliation":[{"name":"Department of Anesthesia, Centre of Head and Orthopedics Rigshospitalet, University of Copenhagen  Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karl Peter Damg\u00e5rd","family":"Madsen","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Centre of Head and Orthopedics Rigshospitalet, University of Copenhagen  Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mikkel Helmuth","family":"Jensen","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Centre of Head and Orthopedics Rigshospitalet, University of Copenhagen  Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Magnus Fuhr","family":"Hovind","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Centre of Head and Orthopedics Rigshospitalet, University of Copenhagen  Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Morten","family":"Sonne","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Centre of Head and Orthopedics Rigshospitalet, University of Copenhagen  Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Morten","family":"B\u00f8ttger","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Centre of Head and Orthopedics Rigshospitalet, University of Copenhagen  Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arash","family":"Afshari","sequence":"additional","affiliation":[{"name":"Department of Pediatric and Obstetric Anesthesia Rigshospitalet, University of Copenhagen  Copenhagen Denmark"},{"name":"Department of Clinical Medicine University of Copenhagen  Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frederik","family":"Mondrup","sequence":"additional","affiliation":[{"name":"Department of Pediatric and Obstetric Anesthesia Rigshospitalet, University of Copenhagen  Copenhagen 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