The huge inter-individual variability of the pharmacokinetic response to relaxant drugs requires active monitoring

Quantitative measurement is very important to tailor the blockade according to surgical needs, on the one hand when the surgeon wants a deep block, and to enable safe reversions from anesthesia on the other. Reliable neuromuscular transmission monitoring is essential to cope with the huge inter-individual variability in the pharmacokinetic response to a given relaxant drug. This can be easily seen for individuals who have received an induction dose of rocuronium only and no top-up doses anymore. You'll see a huge discrepancy among the time needed to recover the TOF ratios as recorded from each individual. Some are fast metabolizers and can recover in twenty minutes such as, for example, people who had a burn. And others are extremely slow to recover, probably due to enzyme deficiencies. In any case, you never know in advance from your patient to which category he/she belongs. You can even find a patient who after several hours could not return above 0,6 TOF ratio. This can happen, and therefore, this is a strong argument in favor of objectively measuring NMT.

RGB Medical Devices is the only manufacturer of the new generation of NMT monitors, based CMG technology. The monitor VISION DUO contains the NMTCuff® technology inside. It destroys the myth that electrode placement is the Foundation of Reliable Neuromuscular Monitoring . With this ground breaking technology you simply don't care about these stickers, you are always confident with easy and fast cuff placement and the autopilot system.

OR Revolution: How Quantitative NMT Monitoring Reduces Costs and Elevates Care Quality

Precise management of neuromuscular transmission (NMT) during surgery is essential for improving hospital efficiency and patient outcomes. Quantitative monitoring such as compressomyography (CMG) in the VISION DUO from RGB Medical Devices delivers measurable clinical and economic advantages.

The Challenge: Hidden Costs and Staff Burden

Traditional, subjective methods of assessing neuromuscular blockade often fail to detect postoperative residual curarization(PORC), a complication occurring in up to 24% of patients when monitoring is absent. This increases the risk of respiratory events, reintubations, and extended hospital stays—placing additional strain on clinical teams. Moreover, inaccurate sugammadex dosing contributes to unnecessary drug waste. Even after a 50% price reduction, losses can exceed €50,000 per OR annually.

The Solution: Precision and Efficiency with Quantitative NMT Monitoring

VISION DUO’s CMG technology delivers objective, real-time data—eliminating guesswork and enabling precise, patient-specific control.

Proven Benefits (References available upon request):Enhanced Patient Safety & Fewer Complications

• Elimination of PORC: Confirms a consistent 100% TOF ratio before extubation, preventing residual paralysis.
• Fewer Postoperative Events: In major laparoscopic urologic surgeries, overall complications fell from 41.7% to 22.3% (p<0.001), medical complications from 29.6% to 11.5% (p<0.001), and reoperations from 7.8% to 2% (p=0.035).

Cost Savings Through Optimized Drug Use

• More Precise Sugammadex Dosing: Enables 20–30% reductions in drug consumption, saving €10,000 to €15,000 per OR annually.
• Safe Repackaging: Supports efficient division into smaller doses, maximizing usage. In many cases, these savings can offset the cost of implementing NMT monitoring hospital-wide within a year.

Greater Operational Efficiency & Shorter Hospital Stays

• Faster, Safer Extubation: CMG detects arm-muscle response 5–10 minutes earlier than traditional wrist monitoring. Paired with sugammadex’s action time of under 2 minutes, this accelerates recovery without lengthening surgery.
• Reduced ICU Use: ERAS protocols using NMT and sugammadex lower ICU ventilation time by 149.4 minutes (p<0.001) and cut ICU admission rates from 100% to 28.9%.
• Shorter Length of Stay: For cervical spine surgery, LOS decreased by 0.62 days, reducing per-patient hospital costs by NTD 13,174.40 (p<0.001).

Conclusion: Better Outcomes, Smarter Spendin
Quantitative NMT monitoring is a high-impact investment. By improving safety, optimizing medication use, and boosting workflow efficiency, hospitals can simultaneously enhance care quality and achieve measurable cost reductions.
This is a clear example of how best practices deliver value for patients, professionals, and healthcare systems alike.

Why Does Compressomygography (CMG) Enhanced by NMTCuff® Offers Greater Assurance in Avoiding Residual Blockade as Compared to Acceleromyography (AMG) or Electromyography (EMG)?

Did you know that NMTCuff® technology—inside equipments like the VISION DUO—uses an advanced algorithm that determines extubation readiness based on complete recovery, rather than relying solely on the traditional 0.9 TOF ratio threshold?

Unlike conventional systems, NMTCuff® can align with 0.9 TOFr-based criteria, but it goes further: it provides a more precise and reliable indication of when extubation can occur safely. By targeting a stable, fully recovered neuromuscular state, NMTCuff® helps reduce the risk of residual blockade.

A standout feature is the AUTO-PILOT mode in the VISION DUO, which leverages NMTCuff® to achieve a “100% TOFr consolidated value.” This means it doesn’t just confirm a single threshold—it ensures recovery is stable and reproducible. The system continuously monitors and identifies the optimal moment for extubation, enhancing patient safety and aligning with expert recommendations for quantitative neuromuscular monitoring.

One of the key advantages of NMTCuff®—which stimulates at the upper arm rather than the wrist (as in AMG or EMG)—is the physiological difference in muscle response. Recovery appears earlier in the upper arm than in the wrist, creating a natural “time window” of about 5 to 10 minutes. During this period, the system can confirm recovery with multiple stable TOF ratio readings—without extending surgical time.

In essence, NMTCuff® takes advantage of this physiological lead time, combining it with automated, high-precision monitoring to ensure complete reversal. This results in a safer, more efficient extubation process that can reduce both perioperative complications and associated costs.

CMG is the new NMT monitoring generation. Please do not miss the next conference in the Carolina University next Wednesday 18th at 11:15am by Dr Wade Weigel.

https://www.med.unc.edu/anesthesiology/carolina-refresher-course/

Thursday, June 19th

• 11:15 - 11:45 am: Monitoring and Antagonism of Neuromuscular Blockade:
• ASA Practice Guidelines (PS)
• Wade Weigel, MD

Friday, June 20th

• 12:00 - 1:00 pm: Workshops / Problem-Based Learning Discussion (PBLD)
• Workshop 3: Quantity vs. Quality: A Comparison of Various Neuromuscular Monitoring Devices
• Wade Weigel, MD
  

Euroanesthesia 2025

¡Estamos emocionados de compartir que nuestra participación en la feria ESA en Lisboa ha sido un gran éxito! El compromiso de RGB con la innovación ha podido ser valorado por los asistentes, quienes han podido explorar nuestra tecnologia NMT Cuff para la medida de la relajación muscular, diseñado para ayudar a evitar el efecto PORC y facilitar el trabajo a los anestesiólogos con nuestro innovador modo AUTO-PILOT.

Agradecemos a todos los que visitaron nuestro stand y compartieron su entusiasmo por nuestra misión de aumentar la seguridad del paciente y mejorar los resultados de la atención médica.

VISION DUO in Carolina Refresher Course

Dr. Wade Weigel, MD

My intent is to provide a balanced and evidence-based overview of the various devices available. My interest is to educate on quantitative monitoring and support product purchase decision making for the attendees. I do not care which product they choose to buy, but I want to help them make an informed decision.

Download the schedule of the Carolina Refresher Course:

ESA 2025 - NMT Tour

The tour led by Prof. Thomas Fuchs-Buder (Nancy, France) will navigate you through the of Neuromuscular transmission monitoring. In 2023 both, the American Society of Anesthesiologists (ASA) and the European Society of Anaesthesiology and Intensive Care (ESAIC) independently published a practice guideline for the management of neuromuscular blockade. After a short introduction, companies Idmed,Senzime and RGB Medical will present their solutions, and you will have the opportunity to discover the latest innovations and discuss directly the experts.