{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,6,6]],"date-time":"2025-06-06T17:51:30Z","timestamp":1749232290594,"version":"3.40.5"},"reference-count":24,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2024,6,14]],"date-time":"2024-06-14T00:00:00Z","timestamp":1718323200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Purpose<\/jats:title>\n<jats:p>To determine the effect of tetanic stimulation on the time to achieve stabilization of the T1 height, by acceleromyography train-of-four (TOF) ratio monitoring, in patients aged 60 to 80 years.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Randomized, prospective, single-blind, controlled trial in patients aged 60 to 80 years undergoing elective surgery under general anesthesia in two university hospitals in Brazil between December 2019 and March 2022. This trial was performed in accordance with the principles of the Helsinki Declaration and the guidelines for good clinical research practice in pharmacodynamic studies of neuromuscular blocking agents II. Participants were randomly allocated by computer-generated numbers to receive tetanic stimulation (intervention group, n\u2009 = \u200925) or not receive tetanic stimulation (control group, n\u2009 = \u200925) to achieve T1 height stabilization on TOF ratio monitoring. The primary endpoint was to evaluate the effect of tetanic stimulation on the time to achieve stabilization of the T1 height. We also evaluated the effect on the onset time of rocuronium and time to recover from neuromuscular blockade with a single dose of rocuronium 0.6 mg.kg<jats:sup>-1<\/jats:sup> with spontaneous recovery.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>There was no statistically significant difference between the groups in the time to T1 height stabilization (intervention: 4.3 [2.0\u20138.0] min; control: 5.8 [2.0\u201310.5] min; p\u2009 = \u20090.202), onset time of the neuromuscular blocking agent (intervention: 1.9 [\u00b10.7] min; control: 2.2 [\u00b11.0] min; p\u2009 = \u20090.219), or neuromuscular blockade recovery times to normalized TOF values of 0.7 (intervention: 106.1 [\u00b137.2] min; control: 91.7 [\u00b127.5] min; p\u2009 = \u20090.295), 0.8 (intervention: 114.3 [\u00b140.1] min; control: 97.8 [\u00b128.9] min; p\u2009 = \u20090.225), 0.9 (intervention: 126.5 [\u00b144.0] min; control: 106.9 [\u00b130.6] min; p\u2009 = \u20090.153), and 1.0 (intervention: 138.3 [\u00b143.4] min; control: 123.8 [\u00b143.5] min; p\u2009 = \u20090.425).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>The results of this study suggest that the recommendation to use tetanic stimulation to shorten the time to T1 height stabilization in neuromuscular monitoring did not alter the stabilization time of the T1 twitch or the pharmacodynamics of neuromuscular blockade with rocuronium in patients aged 60 to 80 years.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0303161","type":"journal-article","created":{"date-parts":[[2024,6,14]],"date-time":"2024-06-14T17:27:45Z","timestamp":1718386065000},"page":"e0303161","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Effect of tetanic stimulation prior to train-of-four monitoring on the time to muscle response stabilization with neuromuscular blockade with rocuronium in patients aged 60 to 80 years: A prospective randomized controlled trial"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4253-8792","authenticated-orcid":true,"given":"Angela","family":"Henrique Silva Ribeiro","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0400-2869","authenticated-orcid":true,"given":"Nubia","family":"Ver\u00e7osa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Est\u00eav\u00e3o Luiz Carvalho","family":"Braga","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angelo Jorge Queiroz Rangel","family":"Micuci","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paulo Al\u00edpio","family":"Germano-Filho","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0412-2609","authenticated-orcid":true,"given":"Ismar Lima","family":"Cavalcanti","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2024,6,14]]},"reference":[{"key":"pone.0303161.ref001","doi-asserted-by":"crossref","first-page":"964","DOI":"10.1097\/ALN.0b013e31826f8fdd","article-title":"Intraoperative neuromuscular monitoring site and residual paralysis","volume":"117","author":"SR Thilen","year":"2012","journal-title":"Anesthesiology"},{"key":"pone.0303161.ref002","doi-asserted-by":"crossref","first-page":"901","DOI":"10.1097\/ALN.0000000000004174","article-title":"Quantitative neuromuscular monitoring in clinical practice: a professional practice change initiative","volume":"136","author":"WA Weigel","year":"2022","journal-title":"Anesthesiology"},{"key":"pone.0303161.ref003","doi-asserted-by":"crossref","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":"T Fuchs-Buder","year":"2023","journal-title":"Eur J Anaesthesiol"},{"key":"pone.0303161.ref004","doi-asserted-by":"crossref","first-page":"2047","DOI":"10.1213\/ANE.0000000000002927","article-title":"World Health Organization-World Federation of Societies of Anaesthesiologists (WHO-WFSA) international standards for a safe practice of anesthesia","volume":"126","author":"AW Gelb","year":"2018","journal-title":"Anesth Analg"},{"key":"pone.0303161.ref005","doi-asserted-by":"crossref","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":"SR Thilen","year":"2023","journal-title":"Anesthesiology"},{"key":"pone.0303161.ref006","doi-asserted-by":"crossref","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":"B Debaene","year":"2003","journal-title":"Anesthesiology"},{"key":"pone.0303161.ref007","doi-asserted-by":"crossref","first-page":"789","DOI":"10.1111\/j.1399-6576.2007.01352.x","article-title":"Good clinical research practice in pharmacodynamic studies of neuromuscular blocking agents II: the Stockholm revision","volume":"51","author":"T Fuchs-Buder","year":"2007","journal-title":"Acta Anaesthesiol Scand"},{"key":"pone.0303161.ref008","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1097\/00000542-199701000-00008","article-title":"Improving the design of muscle relaxant studies. 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