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Abstract

Background: Accurate assessment of neuromuscular blockade recovery is critical for safe tracheal extubation. Train-of-four (TOF) monitoring at different muscle sites, particularly the adductor pollicis (AP) and corrugator supercilii (CS), may vary in their ability to predict adequate recovery.
Aim: To compare the efficacy of AP and CS muscle monitoring using TOF in assessing adequate neuromuscular recovery for tracheal extubation.
Methods: A prospective observational study was conducted on 60 patients undergoing laparoscopic abdominal surgeries under general anaesthesia at Narayana Medical College. Patients were allocated into two groups: Group AP (n=30) received TOF monitoring at the adductor pollicis, and Group CS (n=30) at the corrugator supercilii. Anaesthetic management was standardized. Parameters including TOF ratio, BIS, hemodynamics, extubation criteria, and Ramsay sedation scores were recorded when TOF ≥ 0.9.
Results: There were no significant differences in demographic variables. However, at TOF 0.9, the CS group showed significantly lower BIS, heart rate, and blood pressure values (p < 0.0001), indicating deeper anaesthetic depth and better hemodynamic stability. Extubation criteria were met in 90% of the CS group and 92% of the AP group. Ramsay sedation scores were higher in the CS group, suggesting better sedation at similar TOF values.
Conclusion: Corrugator supercilii monitoring provides a reliable and earlier indication of adequate neuromuscular recovery and is associated with better hemodynamic and sedation profiles than the adductor pollicis. It is a superior site for TOF monitoring during emergence and extubation.