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Monitoring and Antagonism of Neuromuscular Blockade (Published January 2025)
This guideline provides evidence-based recommendations for the management of neuromuscular monitoring and the antagonism of neuromuscular blocking agents during and after general anesthesia. It emphasizes best practices for the type and site of monitoring, as well as safe and effective reversal of neuromuscular blockade to reduce the incidence of residual paralysis and improve patient outcomes.
Residual neuromuscular blockade is a significant yet preventable contributor to postoperative complications, including respiratory events and delayed recovery. This guideline is critical in promoting safer anesthesia care by recommending quantitative monitoring techniques and evidence-based strategies for pharmacological antagonism. It reinforces the use of objective neuromuscular monitoring at the adductor pollicis and a train-of-four (TOF) ratio ≥0.9 before extubating. Proper implementation of these practices enhances airway safety, reduces unplanned ICU admissions, and supports faster, safer patient recovery.
ASA has developed a variety of practical resources, including a pocket guide featuring key recommendations, monitoring modalities, assessment sites, and reversal options. Additional context and expert perspectives are available through related news releases. Together, these materials help clinicians apply the recommendations in the guideline across different practice settings, improving patient safety and reducing the risk of residual neuromuscular blockade.
Last updated by: Department of Quality and Practice Guidelines
Date of last update: June 9, 2025
