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   Response - Individual participant data that underlie the results reported in this article, after de-identification (text, tables, figures, and appendices).
   


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   Response -  Study Protocol
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   Response - Researchers who provide a methodologically sound proposal.
   


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   Response - For individual participant data meta-analysis.
   


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   Response - Proposals should be directed to [hipreeti20@gmail.com].
   


6. For how long will this data be available start date provided 01-03-2022 and end date provided 31-12-2029?
   Response - Immediately following publication. No end date.
   


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   Additional Information - nil

A wide range of surgeries are done under general anaesthesia, and the maintenance of muscle relaxation is important in facilitating surgical procedures.Neuromuscular blocking agents (NMBA), which are used in facilitation of intubation for general anaesthesia and maintenance of muscle relaxation during the surgery, pose risk of residual paralysis. Residual paralysis (RP) after neuromuscular blockade (NMB) in the recovery room occurs in around 56.5% of patients, and it can increase the incidence of airway obstruction, hypoxaemia and postoperative pulmonary complications. 

Neuromuscular Transmission monitoring (NMTM) is a means to determine the degree of NMB by stimulating a motor nerve with electric current and observe the degree of contraction of the muscles innervated by that nerve. It is used to evaluate the effect of  NMBA. The muscle response after stimulation of its corresponding motor nerve is assessed. The most frequently assessed nerve-muscle unit is the ulnar nerve and the adductor pollicis muscle.The muscle response can be evaluated either qualitatively or quantitatively. Qualitative (subjective) assessment is done with a peripheral nerve stimulator, where the observer evaluates the muscle response either tactically or visually. Quantitative assessment is done with the monitor and the response is objectively measured and displayed on a screen.Mechanomyography, electromyography and acceleromyography are such muscle response recording methods in quantitative monitoring. The types of stimuli used in NMTM are single stimulus, train of four (TOF) and post tetanic count (PTC).The TOF technique has remained the most useful method for assessing neuromuscular function for more than 40 years because it is simple and easy to assess. It is based on the observation that increased stimulation frequency produces muscle fatigue or fade. The proportion that results from dividing the fourth by the first evoked twitch (T4/T1) is the train-of-four ratio (TOFR). TOF has been recommended in clinical practice because it is the test that measures neuromuscular function and is capable of providing information even when no prior value has been obtained. TOF count is an excellent guide considering that it reports not only the degree of neuromuscular block but also the state of recovery from it. In most of the centers, the subjective assessment of recovery from the effect of a NMBA is done by observing eye‑opening, tongue protrusion, head lift and sustained hand grip for more than 5 seconds. 

Our study would like to evaluate the efficiency of the use of objective neuromuscular transmission monitoring by TOF when compared to subjective assessment in guiding the frequency of repeating the NMBAs during surgery and in assessing adequacy of reversal from NMBA at the time of recovery from generalanaesthesia and in incidences of postoperative residual paralysis.