Correspondence  |   August 2018
In Reply
Author Notes
  • University of Chicago Pritzker School of Medicine, Chicago, Illinois (G.S.M.).
  • (Accepted for publication May 8, 2018.)
    (Accepted for publication May 8, 2018.)×
Article Information
Correspondence   |   August 2018
In Reply
Anesthesiology 8 2018, Vol.129, 384-385. doi:10.1097/ALN.0000000000002297
Anesthesiology 8 2018, Vol.129, 384-385. doi:10.1097/ALN.0000000000002297
We thank Drs. Phillips and Stewart for their interest in our article.1  The effect of neostigmine when given at the time neuromuscular recovery remains controversial, and Drs. Phillips and Stewart raise some important questions. We welcome the opportunity to respond to their queries.
We agree that we did not determine whether neostigmine induced depolarizing neuromuscular blockade. In order to assess this outcome measure, single twitch height must be recorded before and after muscle relaxant administration. In our clinical trial, we objectively evaluated muscle strength recovery by determining train-of-four ratios.1  No patient exhibited evidence of neostigmine-induced muscle weakness, as train-of-four ratios did not decrease in any subject. Both quantitative techniques (single twitch height and train-of-four ratios) are effective in objectively measuring muscle strength, and further studies are needed to assess the effect of neostigmine on single twitch height.