The multicenter, prospective, observational data from the POPULAR study did not show a significant decrease in postoperative pulmonary complications when either sugammadex was used instead of neostigmine as a reversal agent or with extubation at a train-of-four ratio > 0.9. However, the reanalysis of the same data showed that postoperative pulmonary complications were reduced when patients were extubated at the train-of-four ratio > 0.95 instead of >0.9. For a more in-depth discussion of the POPULAR study reanalysis, see the editorial by Fuchs-Buder and Brull:

Is less really more? A critical appraisal of a POPULAR study reanalysis. The editorial also discusses some of the significant disadvantages of acceleromyography-based twitch monitors such as Stimpod.

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