Adequacy of muscle relaxation

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Clinical signs of return of muscle tone include retraction of the wound edges during abdominal operations and abdominal muscle, diaphragmatic or facial movement. An increase in airway pressure (with a time- or volume-cycled ventilator) may indicate a return of muscle tone. Quantitative estimation of neuromuscular status may be obtained with a peripheral nerve stimulator (see Ch. 38). Small increments (e.g. 25-35% of the original dose) of muscle relaxant may be given to maintain relaxation; alternatively, an i.v. infusion may be a more convenient method of administration, but the use of a peripheral nerve stimulator is mandatory with this technique.

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