The train of four is a test we use in anesthesia to measure the patients level of neuromuscular blockade (paralytic). Four consecutive stimuli are delivered along the path of the nerve. We most commonly monitor the ulnar nerve and/or facial nerve. Once we administer paralytic, the “twitches” will diminish giving us an idea of how relaxed the patient is for the procedure. Paralytic helps ensure the patient does not move during the operation and it also can assist with mechanical ventilation if th