In the PACU, train-of-four (TOF) monitoring shows a ratio of 0.6 in a patient who received rocuronium. This finding is clinically significant because it is associated with:

• A Increased risk of PONV
• B Impaired pharyngeal function and airway obstruction ✓
• C Emergence delirium
• D Postoperative cognitive dysfunction

Explanation

A TOF ratio below 0.9 indicates residual neuromuscular blockade. Even with apparent clinical recovery (head lift, hand grip), TOF < 0.9 is associated with upper airway obstruction, impaired pharyngeal function, impaired hypoxic ventilatory response, and increased aspiration risk. This is a major cause of PACU respiratory complications. It is not directly linked to PONV, delirium, or POCD.

Reference: Miller's Anesthesia, 9th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.