Correspondence  |   August 2018
Catching a Unicorn: Neostigmine and Muscle Weakness—Not Neostigmine for All, but Quantitative Monitoring for Everyone!
Author Notes
  • Sydney Adventist Hospital Clinical School, Sydney Medical School, University of Sydney, NSW, Australia (S.P.). stephanie.phillips@sydney.edu.au
  • (Accepted for publication May 8, 2018.)
    (Accepted for publication May 8, 2018.)×
Article Information
Correspondence
Correspondence   |   August 2018
Catching a Unicorn: Neostigmine and Muscle Weakness—Not Neostigmine for All, but Quantitative Monitoring for Everyone!
Anesthesiology 8 2018, Vol.129, 381-382. doi:10.1097/ALN.0000000000002295
Anesthesiology 8 2018, Vol.129, 381-382. doi:10.1097/ALN.0000000000002295
We read the paper by Murphy et al.1  with great interest. Their conclusions that administration of 40 μg/kg of neostigmine after recovery of the train-of-four ratio to greater than 0.9 (measured with acceleromyography) causes no subsequent decrease in the train-of-four ratio, nor clinical signs of muscle weakness at around 15 min after administration, are supported by their well-constructed study. They restate the 2016 editorial “that neostigmine should be routinely administered unless full neuromuscular recovery has been documented with quantitative neuromuscular monitoring.”1,2 
However, we would like to respectfully question five areas of the study.