The train of four is a test we use in anesthesia to measure the patients level of neuromuscular blockade (paralytic). Four consecutive stimuli are delivered along the path of the nerve. We most commonly monitor the ulnar nerve and/or facial nerve. Once we administer paralytic, the “twitches” will diminish giving us an idea of how relaxed the patient is for the procedure. Paralytic helps ensure the patient does not move during the operation and it also can assist with mechanical ventilation if th
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SOMETHING ON THE TRAIN OF 4 1. Developed by Ali and associates in the 1970s 2. It assesses the ratio of the amplitide, twitch strength of the 4th to the 1st twitch - T4/T1 3. It entails the use of supramaximal nerve stimulation at 2 Hz in 0.5 second intervals over 2 seconds. 4. The abductor pollices muscle is used as it recovers after the larynx and diaphragm. 5. With % receptor block, - the 4th twitch disappears when there is 75% receptor block - the 3rd twitch disappears when there is 80% rece
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