Sep 11, 2018 · In 1970, Ali et al. developed and published the technique of Train of Four (TOF) monitoring (Ali HH, 1970). TOF pattern was developed for assessing neuromuscular block in the anesthetized patient.

Train-of-four monitoring responses: 1/4 to 2/4 twitches: the goal of titrating the NMBA to maintain 85-90% has been achieved. Maintain current rate of infusion. Repeat TOF test hourly. 0/4 twitches: suggests that the level of paralysis is too high and the patient is at risk of developing complications of prolonged skeletal muscle weakness.

Oct 26, 2016 · Several studies have shown that the ratio of the 4th response to the 1st response in the TOF sequence (TOF ratio) should return to at least 90% to ensure full control of pharyngeal and respiratory muscles and to maintain a normal hypoxic ventilatory response.

We suggest the use of quantitative, objective measurement of neuromuscular function (ie, accelerometry, electromyography [EMG], kinemyography [KMG]) to monitor administration of and recovery from neuromuscular blocking agents (NMBAs) whenever possible.

Jan 29, 2024 · The Train-of-Four method is a method for assessing muscle relaxation brought on by drugs. It is more sensitive than a single twitch response. Depending on the medication and level of relaxation, there are different relationships between the train-of …

Train of Four (TOF) testing is a method of measuring the degree of neuromuscular blockade through the use of a peripheral nerve stimulator. The goal of TOF monitoring is to ensure the minimum amount of NMBA is administered to adequately paralyze the patient.

For all NMBA orders, a goal train -of-four (TOF) should be specified. For most ICU patients, the goal level of paralysis is 1 to 2 twitches ( TOF 1 to 2 out of 4; see section C for train-of-four monitoring).

Optimize analgesia to BPS <6 and sedation to RASS -4 to -5. • Document the baseline mA & location at which the patient twitches 4 out of 4, and all proceeding TOF assessments. • If patient remains at the TOF goal and clinical goal, assess TO4 at …

Apr 14, 2023 · Train-of-four (TOF) is the most common pattern of nerve stimulation and involves delivering four equal stimuli at 2-Hz. Train-of-four count (TOFC) is the simple count of muscle twitches resulting from TOF stimulation (range is 0/4 to 4/4) and correlates with the degree of receptor blockade.

The TOFscan is a neuromuscular transmission monitor for monitoring the neuromuscular block of a patient in the operating theatre, recovery room or intensive care unit. Long-term use of neuromuscular blocking agents (NMBAs) can result in prolonged neuromuscular blockade and skeletal muscle weakness.