Editorial Views  |   January 2018
How to Catch Unicorns (and Other Fairytales)
Author Notes
  • From the Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine, Jacksonville, Florida (S.J.B.); and the Department of Anesthesiology, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic, Cleveland, Ohio (M.N.).
  • Corresponding article on page 27.
    Corresponding article on page 27.×
  • Accepted for publication September 6, 2017.
    Accepted for publication September 6, 2017.×
  • Address correspondence to Dr. Brull: sjbrull@me.com
Article Information
Editorial Views / Airway Management / Central and Peripheral Nervous Systems / Neuromuscular Diseases and Drugs / Pharmacology
Editorial Views   |   January 2018
How to Catch Unicorns (and Other Fairytales)
Anesthesiology 1 2018, Vol.128, 1-3. doi:10.1097/ALN.0000000000001959
Anesthesiology 1 2018, Vol.128, 1-3. doi:10.1097/ALN.0000000000001959
IN this issue of the journal, Murphy et al.1  review previous studies on the practice of antagonism of neuromuscular block and build a strong case refuting several misunderstandings in anesthesia practice: the myth that neostigmine could result in clinically significant paradoxical neuromuscular weakness; the myth that clinical signs of recovery (e.g., tidal volume, negative inspiratory pressure) and subjective evaluation are reliable indicators of neuromuscular recovery; and the myth that clinical neuromuscular blockade can be managed safely without a monitoring device. To shed light on these common misconceptions, the authors have administered, prospectively and in a blinded fashion, either neostigmine (40 µg/kg) or saline to patients whose neuromuscular function had spontaneously recovered to a nonnormalized train-of-four (TOF) ratio of at least 0.90 to represent standard clinical practice.
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