When using the Train of Four, do you count the number of twitches you see or the number you feel? Sometimes you only see 1 twitch for example, but if you touch the patient, you can feel 2, 3, or even 4.

Thanks!

When using the Train of Four, do you count the number of twitches you see or the number you feel? Sometimes you only see 1 twitch for example, but if you touch the patient, you can feel 2, 3, or even 4.

Thanks!

you count the number that you see. the ones that you feel are the electrical current. If you are having difficulty seeing the twiching try placing the

electrodes in another area.

you count the number that you see. the ones that you feel are the electrical current. If you are having difficulty seeing the twiching try placing the

electrodes in another area.

It doesn't make a significant difference if you palpate or observe TOF, here is an abstract you might be interested in:

Comparison of visual and measured train-of-four recovery after vecuronium-induced neuromuscular blockade using two anaesthetic techniques

DA O'Hara, RJ Fragen and CA Shanks

This study evaluated train-of-four recovery after the administration of vecuronium, comparing measured with visually observed responses. Responses to supramaximal stimuli of the ulnar nerves were measured by a force transducer, and compared with visually observed movements of the contralateral thumb. For the 10 patients anaesthetized with nitrous oxide and enflurane, the second, third and fourth twitches visually reappeared at 84 (+/- 10)%, 76 (+/- 11)%, and 70 (+/- 12)% measured blockade, respectively. For the other 10 patients, anaesthetized with a narcotic-barbiturate technique, the second, third and fourth twitches reappeared at 81 (+/- 8)%, 68 (+/- 9)%, and 59 (+/- 11)%. These results were not different for the two anaesthetic techniques.