Inside the innovation: exploring TetraGraph® Level-of-Block Gauge™, trend views, and user feedback
June 26, 2025
By Linnea Troeng, Sr. Global Product Manager
Over the years, we’ve continuously refined our products based on invaluable feedback from clinicians and customers.
In this blog, we will highlight the latest improvements and how user input has directly shaped the development of the next-generation TetraGraph® and its powerful new features.
In recent months, we’ve engaged with users across the globe and gathered inputs from key opinion leaders. Their insights have been instrumental in shaping the development of our next-generation TetraGraph electromyography (EMG) monitor.
We iterated on multiple user interface prototypes to incorporate this great feedback—a heartfelt thank you to everyone who contributed!
Ultimately, our goal has always been to simplify neuromuscular monitoring in the operating room (OR).
Through our conversations with clinicians, it became clear that many users found it challenging to interpret the train-of-four (TOF) ratio, TOF counts, and post-tetanic counts (PTC) and how it correlates with the patient's level of neuromuscular block.
To address this, we introduced the TetraGraph Level-of-Block Gauge in the new user interface.
This feature—aligned with current U.S. and European guidelinestranslates TOF ratio, TOF counts, PTC, and bar graphs into a more intuitive, visual display.
Initial feedback has been overwhelmingly positive.
Medical students and clinicians with limited TOF monitoring experience can quickly interpret the patient’s neuromuscular status, while experienced users still benefit from full access to bar graphs, EMG waveforms, and numerical readings.
The Level-of-Block Gauge makes neuromuscular monitoring more accessible and intuitive, bridging the gap between complex data and clinical decision-making.
-Peter Boelhouwers, Head of Anesthesia, Zuger Kantonsspital, Switzerland
Leveraging thousands of real-case data points and insights from practicing anesthesiologists, we built a comprehensive database that underpins our sixth-generation EMG algorithm. This deep analysis enables the next-generation TetraGraph to detect true EMG signals with 4x higher resolution while filtering out noise and minimizing false readings.
For example, in one case, the surgical team aimed to maintain a deep neuromuscular block (TOFC<0).
Thanks to TetraGraph’s precision, clinicians were able to re-dose muscle relaxants appropriately and administer sugammadex at the right time. This approach ensured safe recovery(TOFR >90%) before extubation.
The new trend view on next-generation TetraGraph offers a full-screen display of case data, allowing clinicians to visualize trends in real time or zoom in on specific time intervals.
For manual documentation, you can pause the trend view and move a pointer (red line) to display exact TOF and PTC values (see Picture above).
As an example in the picture to the left, TetraGraph Level-of-Block Gauge confirms full recovery in a patient, consistent with clinical guidelines.
Faded needle positions show previous measurements, providing a short-term trend. A signal strength indicator (green icon in the upper-left corner) ensures measurement accuracy and reliability, so you can have confidence in the readings throughout the case.
Me and my colleagues are happy to guide you and answer any questions you might have.
Linnea Troeng, Sr. Global Product Manager Senzime
