Improving Patient Outcomes with Quantitative TOF Monitoring

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.

Debra J. Faulk, MD
Associate Professor of Anesthesiology-Pediatric Anesthesiology
University of Colorado/Children's Hospital Colorado
Aurora, CO
Debra J. Faulk, MD

Dr. Debra Faulk is an associate professor of pediatric anesthesiology and board-certified pediatric anesthesiologist. Her interests include sedation, simulation, pre-operative anxiety, and emergence agitation in kids. Dr. Faulk’s current research is in the monitoring of neuromuscular blockade in pediatric anesthesia, including studies looking a residual neuromuscular blockade as well as validation of objective EMG monitoring and their use for appropriate dosing of sugammadex in children.

Statement of Need

Neuromuscular blocking agents (NMBAs) such as rocuronium and vecuronium are commonly used during general anesthesia, and all patients who are administered an NMBA have the potential to experience unintended post-operative residual neuromuscular blockade (PRNB). Though updated clinical guidelines published in 2023 now strongly recommend quantitative/objective train-of-four (TOF) monitoring of neuromuscular blockade, clinical adoption has been low.

In the first episode of this CMEOCast podcast series, Dr. Faulk and Dr. Renew will help learners to translate data into clinical practice regarding the differences between clinical assessment, qualitative assessment, and quantitative TOF monitoring and their efficacy in detecting residual neuromuscular blockade.

Learning Objective

Identify the effects of clinical assessment, qualitative assessment, and quantitative monitoring on residual 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: JA0007185-0000-23-105-H01-P

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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. Faulk reports no financial relationships to disclose.

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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Improving Patient Outcomes with Quantitative TOF Monitoring
Event Date: 08/31/2023