Train-of-four ratio (TOFR) values from 0.9 to 11 are generally regarded as the ‘gold standard of the absence of residual paralysis’.2–4 In rocuronium-induced paralysis, despite ‘gold standard’ accelerometry TOFR recordings (0.9), relevant fade was detected by isometric mechanographic signals elicited by 5 s of 100-Hz or 200-Hz tetanic stimulations.5,6 This situation fully justifies the design of the present trial, which used tetanic signals for studying the effects of reversal agents. The aim of the present work was to document the reversal effects of sugammadex 2 mg kg−1 or neostigmine/atropine 40/15 μg kg−1 boluses with repetitive 5-s 100-Hz stimulations5 using strictly standardised conditions.
