{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T17:43:28Z","timestamp":1791913408557,"version":"4.3.4"},"reference-count":40,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2024,10,19]],"date-time":"2024-10-19T00:00:00Z","timestamp":1729296000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,2,20]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Purpose<\/jats:title>\n                  <jats:p>To describe neuromuscular monitoring modalities and highlight the importance of neuromuscular monitoring to clinical pharmacy practice.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Summary<\/jats:title>\n                  <jats:p>A growing body of literature and clinical practice guidelines have highlighted the importance of neuromuscular monitoring practices to ensure patient safety during surgery and in the intensive care unit. Understanding neuromuscular monitoring modalities can allow pharmacists to enhance participation in institutional discussions and optimization of neuromuscular blocker administration and reversal practices. We have described the various modalities of neuromuscular monitoring and considerations for using different modalities.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Neuromuscular monitoring should be performed whenever neuromuscular blocking agents are administered. This practice represents an evidence-based approach to minimizing the occurrence of residual neuromuscular blockade and its associated complications.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ajhp\/zxae287","type":"journal-article","created":{"date-parts":[[2024,10,19]],"date-time":"2024-10-19T17:43:46Z","timestamp":1729359826000},"page":"e242-e251","source":"Crossref","is-referenced-by-count":2,"title":["Neuromuscular monitoring: A tutorial for pharmacists"],"prefix":"10.1093","volume":"82","author":[{"given":"Dustin D","family":"Linn","sequence":"first","affiliation":[{"name":"Philips North America , Cambridge, MA"},{"name":"Department of Pharmacy, Parkview Health , Fort Wayne, IN ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J Ross","family":"Renew","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Perioperative Medicine, Mayo Clinic , Jacksonville, FL ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,10,19]]},"reference":[{"key":"2025061611413164100_CIT0001","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1016\/j.jclinane.2018.12.042","article-title":"Incidence, risk factors, and consequences of residual neuromuscular block in the United States: the prospective, observational, multicenter RECITE-US study","volume":"55","author":"Saager","year":"2019","journal-title":"J Clin Anesth"},{"issue":"9","key":"2025061611413164100_CIT0002","doi-asserted-by":"publisher","first-page":"1095","DOI":"10.1111\/j.1399-6576.1997.tb04851.x","article-title":"Residual neuromuscular block is a risk factor for postoperative pulmonary complications. A prospective, randomised, and blinded study of postoperative pulmonary complications after atracurium, vecuronium and pancuronium","volume":"41","author":"Berg","year":"1997","journal-title":"Acta Anaesthesiol Scand"},{"issue":"3","key":"2025061611413164100_CIT0003","first-page":"97","article-title":"Residual neuromuscular blockade: incidence, assessment, and relevance in the postoperative period","volume":"72","author":"Murphy","year":"2006","journal-title":"Minerva Anestesiol"},{"issue":"1","key":"2025061611413164100_CIT0004","doi-asserted-by":"publisher","first-page":"130","DOI":"10.1213\/ane.0b013e31816d1268","article-title":"Residual neuromuscular blockade and critical respiratory events in the postanesthesia care unit","volume":"107","author":"Murphy","year":"2008","journal-title":"Anesth Analg"},{"issue":"1","key":"2025061611413164100_CIT0005","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1097\/ALN.0000000000004379","article-title":"2023 American Society of Anesthesiologists practice guidelines for monitoring and antagonism of neuromuscular blockade: a report by the American Society of Anesthesiologists Task Force on Neuromuscular Blockade","volume":"138","author":"Thilen","year":"2023","journal-title":"Anesthesiology"},{"issue":"2","key":"2025061611413164100_CIT0006","doi-asserted-by":"publisher","first-page":"426","DOI":"10.1213\/01.ane.0000195543.61123.1f","article-title":"Postoperative residual paralysis in outpatients versus inpatients","volume":"102","author":"Cammu","year":"2006","journal-title":"Anesth Analg"},{"issue":"1","key":"2025061611413164100_CIT0007","doi-asserted-by":"publisher","first-page":"71","DOI":"10.1213\/ANE.0000000000002670","article-title":"Consensus statement on perioperative use of neuromuscular monitoring","volume":"127","author":"Naguib","year":"2018","journal-title":"Anesth Analg"},{"issue":"5","key":"2025061611413164100_CIT0008","doi-asserted-by":"publisher","first-page":"1578","DOI":"10.1213\/01.ane.0000204288.24395.38","article-title":"Tactile fade detection with hand or wrist stimulation using train-of-four, double-burst stimulation, 50-hertz tetanus, 100-hertz tetanus, and acceleromyography","volume":"102","author":"Capron","year":"2006","journal-title":"Anesth Analg"},{"issue":"5","key":"2025061611413164100_CIT0009","doi-asserted-by":"publisher","first-page":"649","DOI":"10.1213\/00000539-197509000-00021","article-title":"Train-of-4 quantitation of competitive neuromuscular block","volume":"54","author":"Lee","year":"1975","journal-title":"Anesth Analg"},{"issue":"4","key":"2025061611413164100_CIT0010","doi-asserted-by":"crossref","first-page":"458","DOI":"10.1097\/00000542-198110000-00024","article-title":"Posttetanic count (PTC): a new method of evaluating an intense nondepolarizing neuromuscular blockade","volume":"55","author":"Viby-Mogensen","year":"1981","journal-title":"Anesthesiology"},{"issue":"3","key":"2025061611413164100_CIT0011","doi-asserted-by":"publisher","first-page":"274","DOI":"10.1093\/bja\/62.3.274","article-title":"Double burst stimulation (DBS): a new pattern of nerve stimulation to identify residual neuromuscular block","volume":"62","author":"Engbaek","year":"1989","journal-title":"Br J Anaesth"},{"issue":"5","key":"2025061611413164100_CIT0012","doi-asserted-by":"publisher","first-page":"964","DOI":"10.1097\/ALN.0b013e31826f8fdd","article-title":"Intraoperative neuromuscular monitoring site and residual paralysis","volume":"117","author":"Thilen","year":"2012","journal-title":"Anesthesiology"},{"issue":"3","key":"2025061611413164100_CIT0013","doi-asserted-by":"publisher","first-page":"378","DOI":"10.1177\/0310057X1404200316","article-title":"Comparison of electromyography and kinemyography during recovery from non-depolarising neuromuscular blockade","volume":"42","author":"Stewart","year":"2014","journal-title":"Anaesth Intensive Care"},{"issue":"12","key":"2025061611413164100_CIT0014","doi-asserted-by":"publisher","first-page":"903","DOI":"10.1093\/ajhp\/zxz073","article-title":"ASHP guidelines on perioperative pharmacy services","volume":"76","author":"Bickham","year":"2019","journal-title":"Am J Health-Syst Pharm"},{"issue":"9","key":"2025061611413164100_CIT0015","doi-asserted-by":"publisher","first-page":"e813","DOI":"10.1097\/CCM.0000000000004437","article-title":"Position paper on critical care pharmacy services: 2020 update","volume":"48","author":"Lat","year":"2020","journal-title":"Crit Care Med"},{"issue":"2","key":"2025061611413164100_CIT0016","doi-asserted-by":"publisher","first-page":"501","DOI":"10.1002\/jac5.1185","article-title":"Perioperative clinical pharmacy practice: responsibilities and scope within the surgical care continuum","volume":"3","author":"Patel","year":"2020","journal-title":"J Am Coll Clin Pharm"},{"issue":"3","key":"2025061611413164100_CIT0017","doi-asserted-by":"publisher","first-page":"261","DOI":"10.1093\/ajhp\/zxaa378","article-title":"ASHP guidelines on emergency medicine pharmacist services","volume":"78","author":"Ortmann","year":"2021","journal-title":"Am J Health-Syst Pharm"},{"issue":"1","key":"2025061611413164100_CIT0018","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1097\/ALN.0000000000004578","article-title":"A dose-finding study of sugammadex for reversal of rocuronium in cardiac surgery patients and postoperative monitoring for recurrent paralysis","volume":"139","author":"Bowdle","year":"2023","journal-title":"Anesthesiology"},{"issue":"11","key":"2025061611413164100_CIT0019","doi-asserted-by":"publisher","first-page":"2079","DOI":"10.1097\/CCM.0000000000002027","article-title":"Clinical practice guidelines for sustained neuromuscular blockade in the adult critically ill patient","volume":"44","author":"Murray","year":"2016","journal-title":"Crit Care Med"},{"key":"2025061611413164100_CIT0020","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1186\/s40560-020-00455-2","article-title":"Neuromuscular blockade management in the critically Ill patient","volume":"8","author":"Renew","year":"2020","journal-title":"J Intensive Care"},{"key":"2025061611413164100_CIT0021","author":"Rocuronium bromide injection","year":"2023"},{"key":"2025061611413164100_CIT0022","author":"Cisatracurium besylate injection","year":"2021"},{"issue":"10","key":"2025061611413164100_CIT0023","doi-asserted-by":"publisher","first-page":"1411","DOI":"10.1097\/CCM.0000000000006000","article-title":"Society of Critical Care Medicine clinical practice guidelines for rapid sequence intubation in the critically ill adult patient","volume":"51","author":"Acquisto","year":"2023","journal-title":"Crit Care Med"},{"key":"2025061611413164100_CIT0024","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1016\/j.ijso.2020.08.010","article-title":"Preventive strategies of residual neuromuscular blockade in resource-limited settings: systematic review and guideline","volume":"26","author":"Firde","year":"2020","journal-title":"Int J Surg Open"},{"issue":"5","key":"2025061611413164100_CIT0025","doi-asserted-by":"publisher","first-page":"1042","DOI":"10.1097\/00000542-200305000-00004","article-title":"Residual paralysis in the PACU after a single intubating dose of nondepolarizing muscle relaxant with an intermediate duration of action","volume":"98","author":"Debaene","year":"2003","journal-title":"Anesthesiology"},{"issue":"5","key":"2025061611413164100_CIT0026","doi-asserted-by":"publisher","first-page":"1184","DOI":"10.3390\/life13051184","article-title":"Intraoperative monitoring of neuromuscular blockade","volume":"13","author":"Motamed","year":"2023","journal-title":"Life (Basel)"},{"issue":"2","key":"2025061611413164100_CIT0027","doi-asserted-by":"publisher","first-page":"82","DOI":"10.1097\/EJA.0000000000001769","article-title":"Peri-operative management of neuromuscular blockade: a guideline from the European Society of Anaesthesiology and Intensive Care","volume":"40","author":"Fuchs-Buder","year":"2023","journal-title":"Eur J Anaesthesiol"},{"issue":"3","key":"2025061611413164100_CIT0028","doi-asserted-by":"crossref","first-page":"139","DOI":"10.4037\/ajcc2001.10.3.139","article-title":"A national survey of critical care nurses\u2019 practices related to administration of neuromuscular blocking agents","volume":"10","author":"Foster","year":"2001","journal-title":"Am J Crit Care"},{"issue":"4","key":"2025061611413164100_CIT0029","doi-asserted-by":"publisher","first-page":"575","DOI":"10.1097\/00003246-199704000-00005","article-title":"A prospective, randomized, controlled evaluation of peripheral nerve stimulation versus standard clinical dosing of neuromuscular blocking agents in critically ill patients","volume":"25","author":"Rudis","year":"1997","journal-title":"Crit Care Med"},{"issue":"2","key":"2025061611413164100_CIT0030","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1002\/j.1875-9114.1997.tb03715.x","article-title":"Retrospective pharmacoeconomic evaluation of dosing vecuronium by peripheral nerve stimulation versus standard clinical assessment in critically ill patients","volume":"17","author":"Zarowitz","year":"1997","journal-title":"Pharmacotherapy"},{"issue":"4","key":"2025061611413164100_CIT0031","doi-asserted-by":"publisher","first-page":"1267","DOI":"10.1378\/chest.126.4.1267","article-title":"A prospective randomized comparison of train-of-four monitoring and clinical assessment during continuous ICU cisatracurium paralysis","volume":"126","author":"Baumann","year":"2004","journal-title":"Chest"},{"issue":"3","key":"2025061611413164100_CIT0032","doi-asserted-by":"publisher","first-page":"e0371","DOI":"10.1097\/CCE.0000000000000371","article-title":"The implementation of protocol-based utilization of neuromuscular blocking agent using clinical variables in acute respiratory distress syndrome patients","volume":"3","author":"Hadique","year":"2021","journal-title":"Crit Care Explor"},{"key":"2025061611413164100_CIT0033","doi-asserted-by":"publisher","first-page":"8780979","DOI":"10.1155\/2020\/8780979","article-title":"Considerations in neuromuscular blockade in the ICU: a case report and review of the literature","volume":"2020","author":"Workum","year":"2020","journal-title":"Case Rep Crit Care"},{"issue":"3","key":"2025061611413164100_CIT0034","doi-asserted-by":"publisher","first-page":"e304","DOI":"10.1097\/CCM.0000000000004824","article-title":"Awareness with paralysis in mechanically ventilated patients in the emergency department and ICU: a systematic review and meta-analysis","volume":"49","author":"Pappal","year":"2021","journal-title":"Crit Care Med"},{"issue":"6","key":"2025061611413164100_CIT0035","doi-asserted-by":"publisher","first-page":"1118","DOI":"10.1213\/ANE.0000000000003714","article-title":"Anesthesiologists\u2019 overconfidence in their perceived knowledge of neuromuscular monitoring and its relevance to all aspects of medical practice: an international survey","volume":"128","author":"Naguib","year":"2019","journal-title":"Anesth Analg"},{"issue":"2","key":"2025061611413164100_CIT0036","doi-asserted-by":"publisher","first-page":"345","DOI":"10.1213\/ANE.0b013e3182999672","article-title":"Reversal with sugammadex in the absence of monitoring did not preclude residual neuromuscular block","volume":"117","author":"Kotake","year":"2013","journal-title":"Anesth Analg"},{"issue":"6","key":"2025061611413164100_CIT0037","doi-asserted-by":"publisher","first-page":"619","DOI":"10.1111\/aas.12907","article-title":"Objective neuromuscular monitoring of neuromuscular blockade in Denmark: an online-based survey of current practice","volume":"61","author":"S\u00f6derstr\u00f6m","year":"2017","journal-title":"Acta Anaesthesiol Scand"},{"issue":"2","key":"2025061611413164100_CIT0038","doi-asserted-by":"publisher","first-page":"323","DOI":"10.1213\/ANE.0000000000000261","article-title":"The implementation of quantitative electromyographic neuromuscular monitoring in an academic anesthesia department","volume":"119","author":"Todd","year":"2014","journal-title":"Anesth Analg"},{"issue":"6","key":"2025061611413164100_CIT0039","doi-asserted-by":"publisher","first-page":"901","DOI":"10.1097\/ALN.0000000000004174","article-title":"Quantitative neuromuscular monitoring in clinical practice: a professional practice change initiative","volume":"136","author":"Weigel","year":"2022","journal-title":"Anesthesiology"},{"issue":"3","key":"2025061611413164100_CIT0040","doi-asserted-by":"publisher","first-page":"517","DOI":"10.1213\/ANE.0000000000006722","article-title":"Improving neuromuscular monitoring through education-based interventions and studying its association with adverse postoperative outcomes: a retrospective observational study","volume":"138","author":"Carr","year":"2024","journal-title":"Anesth Analg"}],"container-title":["American Journal of Health-System Pharmacy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ajhp\/advance-article-pdf\/doi\/10.1093\/ajhp\/zxae287\/60011250\/zxae287.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ajhp\/article-pdf\/82\/5\/e242\/60011250\/zxae287.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ajhp\/article-pdf\/82\/5\/e242\/60011250\/zxae287.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,16]],"date-time":"2025-06-16T15:41:40Z","timestamp":1750088500000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ajhp\/article\/82\/5\/e242\/7828162"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10,19]]},"references-count":40,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2024,10,19]]},"published-print":{"date-parts":[[2025,2,20]]}},"URL":"https:\/\/doi.org\/10.1093\/ajhp\/zxae287","relation":{},"ISSN":["1079-2082","1535-2900"],"issn-type":[{"value":"1079-2082","type":"print"},{"value":"1535-2900","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,3,1]]},"published":{"date-parts":[[2024,10,19]]}}}