Discussion
The incidence of rNMB after extubation in pediatric patients with routine use of neostigmine after recovery of spontaneous breathing (experimental group) was not significantly different compared with that in pediatric patients who were provided neostigmine guided by the monitoring of neuromuscular function (control group). Although anesthesiologists were aware of the TOF ratios in the control group, rNMB still occur in 73.3% patients after extubation. A similar result was found in a previous cohort study, in which 64.7% patients had rNMB at tracheal extubation, despite neostigmine administration and qualitative neuromuscular function monitor used [The use of muscle relaxant antagonists at the end of the surgery was reported to be associated with a decreased risk of mortality [This study has some limitations. First, awake pediatric patients are not tolerant of neuromuscular monitoring. Therefore, monitoring of neuromuscular function was not carried out during the PACU stay. Consequently, the incidence of rNMB in the two groups during the PACU stay was unknown. Second, all the pediatric patients in this study were transferred to the PACU after surgery for observation. Therefore, the results of this study do not apply to pediatric patients who need to return to the ward directly after surgery.