We provide the clinically proven standard in neuromuscular monitoring
- Trusted by the world’s leading hospitals
- Used daily by anesthesiologists around the world
- Backed by the highest number of studies in the field
Perioperative neuromuscular monitoring is no longer an option—it’s a necessity.
Leading clinical societies, including ASA and ESAIC, have established guidelines recommending the routine use of quantitative train-of-four (TOF) monitoring to prevent postoperative residual neuromuscular block (PRNB).
Subjective assessment (e.g., visual/tactile monitoring) is insufficient for accurate neuromuscular recovery.
Sugammadex should be part of a comprehensive strategy underpinned by quantitative monitoring.
Both ASA and ESAIC recommend routine use of quantitative neuromuscular monitoring.
EMG-based monitors, such as TetraGraph, have demonstrated superior precision over subjective or acceleromyography (AMG) -based monitoring.
EMG provides consistent and accurate train-of-four ratio (TOFR) measurements, unlike AMG monitors which tend to overshoot despite normalization attempts.
EMG monitors offer significantly better precision and is an ideal choice when the arms are tucked, for example robotic and laparoscopic surgeries.
TetraGraph was shown to achieve the highest accuracy in a validation study, with the least likelihood of over-reading baseline train-of-four ratio measurements.
This data was calculated as 1-Bias vs. MMG 97.9%.
The two leading societies in anesthesiology, ASA and ESAIC, jointly recommends the following:
- Using stimulation of the ulnar nerve – one of the nerves in the hand – with quantitative neuromuscular monitoring at the thumb
- Confirming a TOF ratio greater than or equal to 0.9 before extubation
- Restructuring the clinical environment by placing quantitative monitors in all anesthetizing locations
- Appointing a local champion who is supported by leaders
- The most clinical studies, articles and abstracts supporting its technology.
- Proven accuracy and reliability in leading hospitals and surgical centers worldwide.
- Used in diverse patient populations, from routine cases to complex surgical procedures.
Are you ready to align your practice with the latest guidelines and the most published TOF technology?
References
Ebert TJ, Vogt J, Kaur R, Iqbal Z, Peters D, Cummings CE, Stekiel TA. Train-of-four ratio, counts and post-tetanic counts with the TetraGraph electromyograph in comparison with mechanomyography. Journal of Clinical Monitoring and Computing, August 2024.
Wedemeyer, Z., et al. “Comparative Performance of Stimpod Electromyography with Mechanomyography for Quantitative Neuromuscular Blockade Monitoring.” Journal of Clinical Monitoring and Computing, vol. 38, 2023, pp. 205-212. https://doi.org/10.1007/s10877-023-01087-1.
Bowdle A, Bussey L, Michaelsen K, Jelacic S, Nair B, Togashi K, Hulvershorn J. “A Comparison of a Prototype Electromyograph vs. a Mechanomyograph and an Acceleromyograph for Assessment of Neuromuscular Blockade.” Anaesthesia, vol. 75, 2020, pp. 187-195. https://doi.org/10.1111/anae.14872.
Fuchs-Buder, Thomas; Romero, Carolina S.; Lewald, Heidrun; Lamperti, Massimo; Afshari, Arash; Hristovska, Ana-Marjia; Schmartz, Denis; Hinkelbein, Jochen; Longrois, Dan; Popp, Maria; de Boer, Hans D.; Sorbello, Massimiliano; Jankovic, Radmilo; Kranke, Peter. Peri-operative management of neuromuscular blockade: A guideline from the European Society of Anaesthesiology and Intensive Care. European Journal of Anaesthesiology 40(2):p 82-94, February 2023. | DOI: 10.1097/EJA.0000000000001769
Stephan R. Thilen, Wade A. Weigel, Michael M. Todd, Richard P. Dutton, Cynthia A. Lien, Stuart A. Grant, Joseph W. Szokol, Lars I. Eriksson, Myron Yaster, Mark D. Grant, Madhulika Agarkar, Anne M. Marbella, Jaime F. Blanck, Karen B. Domino; 2023 American Society of Anesthesiologists Practice Guidelines for Monitoring and Antagonism of Neuromuscular Blockade: A Report by the American Society of Anesthesiologists Task Force on Neuromuscular Blockade. Anesthesiology 2023; 138:13–41 doi: https://doi.org/10.1097/ALN.0000000000004379
Fuchs-Buder, Thomas; De Robertis, Edoardo; Thilen, Stephan R.; Champeau, Michael W.. Joint Letter to the Editor from the American Society of Anesthesiologists and the European Society of Anaesthesiology and Intensive Care on Management of Neuromuscular Blockade. European Journal of Anaesthesiology ():10.1097/EJA.0000000000001867, June 02, 2023. | DOI: 10.1097/EJA.0000000000001867
Rodney G, Raju PKBC, Brull SJ. Residual neuromuscular block: time to consign it to history. Anaesthesia 2024; 79: 344-8
Harvey A, Masland R: A method for the study of neuromuscular transmission in human subjects. Bulletin of the Johns Hopkins Hospital 1941; 68: 81-93