Relationship of Train-of-Four (Neuromuscular Monitoring) With Head Lift for Five Seconds During Emergence From General Anesthesia

Objective: To establish relationship between train-of-four ratio and clinical signs including head lift during emergence from general anesthesia. Study Design: Cross Sectional Study. Place and Duration of Study: Combined Military Hospital, Rawalpindi Pakistan, from Apr to Sep 2021. Methodology: A total of 93 patients with age range 18–60 years and ASA (American society of Anesthesiologist’s) physical Status I or II undergoing an elective procedure lasting more than 60 minutes under general anesthesia were included in study. Train-of-four ratio was calculated using a nerve stimulator at the time of extubation followed by the appearance of each clinical sign. Results: Of 93 patients 63(67.7%) were males while 30(32.2%) were females with mean age 35.6±12.5 years. 77(82.7%) patients were graded as ASA-I and 16(17.2%) were graded as ASA-II. The mean duration of surgery was 83.5±8.3 mins however the mean TOFR was 0.35±1.1. At the appearance of each clinical sign mean TOFR was calculated and recorded. The results showed significant relationship between clinical signs (sustained head lift, ability to retain tongue depressor, hand grip 60% of control and ability to cough) and Train-of-four ratio. Conclusion: There is a significant relationship between clinical signs (sustained head lift, ability to retain tongue depressor, hand grip 60% of control and ability to cough) and Train-of-four ratio.