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In patients receiving a neuromuscular blocking agent, quantitative monitoring of neuromuscular function is essential. For this purpose, neuromuscular monitoring devices which provide train-of-four ratio values are necessary In the absence of a quantitative monitoring device, neuromuscular function may be evaluated with the use of a nerve stimulator. Muscle responses can be monitored either using the mechanomyography, electromyography, acceleromyography, or phonomyography. Although, mechanomyography is still considred the gold standard for assessing the neuromuscular function, mechanomyography is not easy to set up and use in a routine clinical setting. At present we have only two commercially available devices which are easy to set up and useful in daily clinical practice. One is M-NMT monitor which comes with Datex AS/3 or S/5 monitor. The other is TOF-Watch acceleromyographic monitor. In clinical anesthesia, sites of monitoring can be any superficially located peripheral nerves and innervated muscles. Since different muscle groups have different sensitivity to neuromuscular blocking agents, results obtained for one muscle cannot be extrapolated to other muscles. Also, results from one monitoring method cannot be extrapolated to other methods. Anesthesiologists should be aware of these differences. In this article, the basics of neuromuscular monitoring are summarized.

1. A new apparatus, consisting of a strain gauge and a carrier amplifier, was devised for measuring back muscular and shoulder arms strength by the author. This apparatus was applied for analysing myogenic disorder related to muscular fatigue or pain. 2. Muscular strength with load and its myogram were recorded simultaneously, and their changes during the exertion were analysed. 3. Muscular strength-myograms of sternocleidomastoid muscle, upper trapezius muscle, deltoid muscle, rhomboid muscle and lumbodorsal muscle were observed from the back muscular strength-myogram, and those of teres minor muscle and major pectoral muscle from the shoulder arm strength-myogram. 4. It seemed paradoxically that the amplitude of action myogram increased in proportion to the grade of lowering of muscular strength caused by muscular fatigue or pain.