Editorial Views  |   November 2018
Workflow Eats Optimum Care for Lunch
Author Notes
  • From the Department of Anesthesiology, Vanderbilt University Medical Center; the Department of Perioperative and Critical Care Services, Vanderbilt University Adult Hospital; the Department of Anesthesiology, Surgery and Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, Tennessee (W.S.S.); and Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine, Jacksonville, Florida (S.J.B.).
  • Corresponding article on page 880.
    Corresponding article on page 880.×
  • Accepted for publication July 19, 2018.
    Accepted for publication July 19, 2018.×
  • Address correspondence to Dr. Brull: sjbrull@me.com
Article Information
Editorial Views / Neuromuscular Diseases and Drugs / Neurosurgical Anesthesia / Technology / Equipment / Monitoring
Editorial Views   |   November 2018
Workflow Eats Optimum Care for Lunch
Anesthesiology 11 2018, Vol.129, 864-866. doi:10.1097/ALN.0000000000002437
Anesthesiology 11 2018, Vol.129, 864-866. doi:10.1097/ALN.0000000000002437
“It is not the strongest of the species that survives, nor the most intelligent, but the one most responsive to change.”
— Charles R. Darwin (1809–1882)
EDITORIALS are meant to place scientific findings in the appropriate clinical context, and this editorial is no exception. It is important to note several limitations of any new technology, particularly when it is meant to replace an older one. Acceleromyography, since its introduction into clinical use by Viby-Mogensen et al. in 1988,1  has become the most widely used method of monitoring (measuring) neuromuscular function, and the initial TOF-Guard (Biometer, Denmark)2  morphed into the TOF-Watch (Organon, Ireland) that, at the time of its production demise in 2016, had a total worldwide installed base of just more than 50,000 units (personal communication, Michael Rosenheimer, MIPM, Germany, May 20, 2016). Despite this miniscule uptake, the TOF-Watch had somehow succeeded in becoming the “standard” (read: “most-used”) device for conducting clinical studies on neuromuscular blockade and its pharmacologic antagonism—a problematic state of affairs, given that the device is disappearing rapidly.