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Both the American Society of Anesthesiologists (ASA) and European Society of Anaesthesiology and Intensive Care (ESAIC) have published new guidelines on the management of neuromuscular blockade during anesthesia. In addition to other recommendations, both guidelines strongly recommend using quantitative neuromuscular monitoring (e.g., electromyography or accelerometry) rather than qualitative assessment and confirming a train-of-four ratio ≥0.9 before extubation. They also recommend using sugammadex for reversal rather than neostigmine for patients who have received rocuronium or vecuronium and who have residual block at or deeper than a train-of-four ratio of 0.4. Our recommendations are consistent with these guidelines.

Some prehabilitation programs include physical exercise training before elective major surgery. In a meta-analysis of 10 randomized trials with over 600 total patients undergoing open or video-assisted resection of non-small cell lung cancer, preoperative aerobic, resistance, and/or respiratory muscle training reduced the risk of postoperative pulmonary complications by over 50% and reduced postoperative hospital stay by more than two days. Similar results were noted in previous systematic reviews. Preoperative exercise training likely has benefits in selected patients undergoing lung resection, particularly those with poor functional capacity.