A reply

Abstract

We appreciate the interest of Naguib and Kopman in our recent review article on monitoring neuromuscular transmission [1]. They express concerns regarding methodological criticism of their meta-analysis. In this meta-analysis Naguib et al. [2] could not demonstrate that the use of an intraoperative neuromuscular function monitoring decreased the incidence of postoperative residual cuarisation. This result was surprising and raised methodological concerns [3]. In the mean time a remarkably well conducted meta-analysis confirmed, that contrary to Naguib et al.’s principle conclusion, objective acceleromyographic monitoring might reduce the incidence of postoperative residual paralysis [4]. Finally, Murphy et al. [5] determined the impact on acceleromyography on postoperative residual paralysis in 185 patients randomised to intra-operative acceleromyography monitoring or conventional train of four monitoring. This paper confirmed that the incidence, severity and duration of clinical manifestations of residual paralysis such as hypoxia and airway obstruction were significantly less in the acceleromyography group compared to the conventional neuromuscular monitoring group. Ultimately, an argument should be considered as false if it has been proven to be false. Thus, after all we have to conclude: can objective neuromuscular monitoring reduce residual paralysis? Yes it can!