What will you observe in a patient with right-sided paralysis when monitoring neuromuscular blockade using a TOF on the right wrist?

When monitoring neuromuscular blockade using a train-of-four (TOF) assessment on a patient with right-sided paralysis, one would expect to observe a greater amplitude of twitches on the right side compared to the left. This is due to the nature of how muscle paralysis works.

In a patient with right-sided paralysis, the nerve supply and muscle function on the right side are compromised; however, the neuromuscular blocker is still effective on both sides of the body. As a result, the left side, which is not paralyzed, will show a full response to the neuromuscular blockade, typically demonstrating weaker twitches than would be expected if the patient had normal function. Conversely, the right side displays less function due to paralysis, which can give a misleading perception of greater twitches, particularly when there are still some residual muscle movements present.

Thus, observing greater amplitude twitches on the right side while monitoring with TOF reflects an incomplete blockade rather than an actual increase in muscle function, resulting from the neuromuscular monitoring process. This highlights the importance of assessing both sides in neuromuscular blockade monitoring to effectively gauge patient response and the effects of the medication used.