Percentage of patients with a documented Train of Four (TOF) after last dose of non-depolarizing neuromuscular blocker.

Postoperative residual neuromuscular blockade can lead to significant complications. Several studies have found associations between the use of neuromuscular blockade agents (NMBA) and residual neuromuscular blockade in the recovery room. Adverse postoperative respiratory outcomes are even more frequent when patients receive NMBA and reversal agents are not used. A mainstay of residual blockade prevention continues to be monitoring to allow for detection, and use of reversal agents like neostigmine and Sugammadex. Due to variability in duration of muscle relaxants, even in defasciculating doses, we recommend that TOF is monitored when any non-depolarizing neuromuscular blockers are administered.

Anesthesia Start to Earliest Extubation

All patients that have received either by bolus or infusion a non-depolarizing neuromuscular blocker (NMB) AND were extubated post-operatively or in the PACU.  The following NMBs are included:

• Atracurium
• Cisatracurium
• Pancuronium
• Rocuronium
• Vecuronium

• ASA 5 and 6 including Organ Procurement (CPT: 01990)
• Patients not receiving neuromuscular blockade
• Patients that were not extubated in the immediate postoperative period (as defined by the earliest time resulted from LMA Removal Times or Extubation Times).
• Procedure Type: Lung Transplant

Documentation of a Train of Four count (1, 2, 3, or 4), sustained tetany, or TOF ratio provided by acceleromyography AFTER last dose or stopping of infusion of neuromuscular blocker and before earliest extubation.  Note: A Train of Four value of ‘0’ is accepted for cases in which Sugammadex is administered for reversal.

*This measure will include valid MPOG cases defined by the Is Valid Case MPOG phenotype.

Not Applicable

The provider(s) signed in at time of earliest extubation.

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