Emergence with residual blockade
Educational use only. Not clinically reviewed58-year-old man for Laparoscopic inguinal hernia repair. About 5 simulated minutes.
What you will practise
- Read the quantitative train-of-four ratio instead of relying on clinical signs or twitch count alone.
- Identify residual neuromuscular blockade when four twitches show no detectable fade but the ratio remains below 0.9.
- Keep the tracheal tube and delivered ventilation in place while recovery is addressed and reassessed.
- Treat quantitative neuromuscular recovery as necessary but not sufficient for a complete extubation decision.
Review and sources
Not clinically reviewed. No clinician has signed this scenario.
- Thilen SR, et al. 2023 ASA Practice Guidelines for Monitoring and Antagonism of Neuromuscular Blockade. Anesthesiology 2023;138:13-41. PMID 36520073.
- Fuchs-Buder T, et al. Peri-operative management of neuromuscular blockade: ESAIC guideline. Eur J Anaesthesiol 2023;40:82-94. PMID 36377554.
Open Sim Lab is an educational simulator, not for clinical use. It is not a clinical decision-support tool, not a dosing calculator, and is not validated for any decision affecting a real patient.