Best Practices in Neuromuscular Monitoring: A Focus On 2023 ASA Guidelines

This activity is part of a series


J. Ross Renew, MD, FASA, FASE
Associate Professor of Anesthesiology
Mayo Clinic College of Medicine and Science
Vice Chair of Research, Department of Anesthesiology and Perioperative Medicine
Mayo Clinic
Jacksonville, FL
J. Ross Renew, MD, FASA, FASE

Ross Renew, MD, FASA, FASE, graduated from Clemson University (Chemistry, BS) and completed medical school at the University of South Carolina School of Medicine. Dr. Renew completed anesthesia residency at Mayo Clinic Florida and his fellowship in adult cardiothoracic anesthesiology at Mayo Clinic in Rochester, MN. Dr. Renew then returned to Jacksonville and has worked on staff at Mayo Clinic Florida, where he is currently an Associate Professor of Anesthesiology. Dr. Renew serves as the Vice Chair of Research and Associate Program Director for the department’s residency program.  His research interests involve neuromuscular blockade and monitoring, transesophageal echocardiography, and caring for the cardiac patient undergoing non-cardiac surgery.

Dru Riddle, PhD, DNP, CRNA, FAAN
Associate Professor & Director of Clinical Education
School of Nurse Anesthesia
Texas Christian University
Fort Worth, TX
Dru Riddle, PhD, DNP, CRNA, FAAN

Dru is an academic and clinically-practicing Certified Registered Nurse Anesthetist (CRNA) and American Association of Nurse Anesthesiology (AANA) President.  He also serves as co-chair of the Cochrane US Network.

Statement of Need

In early 2023, the American Society of Anesthesiologists (ASA) published new guidelines to provide best practices and recommendations for monitoring and antagonism of neuromuscular blockade, with a focus on addressing practice deficiencies and recognizing opportunities to improve patient care in preventing post-operative residual neuromuscular blockade (NMB). Misconceptions about the reliability of non-quantitative methods of train-of-four (TOF) monitoring remain, leading to inadequate assessment of post-operative NMB and inaccurate assessment of the need for reversal. The 2023 ASA guidelines make specific recommendations regarding TOF monitoring methods and use of specific agents for NMB reversal, which inform the current standard of care in anesthesia practice.

In the second episode of the CMEOCast podcast series, J.Ross Renew, MD and Dru Riddle, DNP, CRNA will guide learners through strategies to best incorporate recommendations from the 2023 ASA guidelines into clinical practice.

Learning Objective

Incorporate best practices in the utilization of quantitative TOF monitoring of neuromuscular blockade.

Financial Support

Supported by an educational grant from Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc.

Target Audience

Physicians, nurse practitioners (NPs), physician associates (PAs), nurses, and pharmacists specializing in anesthesiology or surgery

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Activity UAN: JA0007185-0000-23-107-H01-P

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Anesthesiology (ABA MOC)

This activity contributes to the CME component of the American Board of Anesthesiology’s redesigned Maintenance of Certification in Anesthesiology (TM) (MOCA®) program, known as MOCA 2.0®. Please consult the ABA website,, for a list of all MOCA 2.0 requirements.

Surgeons (ABS CC)

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Royal College MOC

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Disclosure Declaration

It is the policy of CME Outfitters, LLC, to ensure independence, balance, objectivity, and scientific rigor and integrity in all of their CE activities. Faculty must disclose to the participants any relationships with commercial companies whose products or devices may be mentioned in faculty presentations, or with the commercial supporter of this CE activity. CME Outfitters, LLC, has evaluated, identified, and mitigated any potential conflicts of interest through a rigorous content validation procedure, use of evidence-based data/research, and a multidisciplinary peer review process.

Dr. Renew reports the following financial relationships:

Research Support: Merck & Co., Inc (Funds to Mayo Clinic)

Dr. Riddle reports the following financial relationships:

Speakers Bureau: Acacia Pharma/Eagle Pharmaceuticals, Inc.

Disclosures were obtained from the following peer reviewer and CME Outfitters, LLC, staff, with no disclosures to report:

  • Michael Franks, APRN, AGACNP-BC, FNP-BC (peer reviewer)
  • Morgan Stockberger, MD (planning committee)
  • Kasey Brandt, PharmD (planning committee)
  • Susan H. Yarbrough, CHCP (planning committee)
  • Sandra Caballero, PharmD (planning committee)
  • Sharon Tordoff (planning committee)

Faculty of this CE activity may include discussions of products or devices that are not currently labeled for use by the FDA. The faculty have been informed of their responsibility to disclose to the audience if they will be discussing off-label or investigational uses (any uses not approved by the FDA) of products or devices.

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Best Practices in Neuromuscular Monitoring: A Focus On 2023 ASA Guidelines
Event Date: 09/26/2023 at 4:00 am EST