Dr. Rodney explains how despite advances in paralytic agents and reversal drugs like sugammadex, the problem of residual neuromuscular blockade has not yet been solved, with studies showing it occurs in 30-40% of cases without quantitative monitoring. He highlights how recent guidelines from ASA, ESAIC, and other major anesthesia societies all definitively recommend quantitative train-of-four ratio monitoring for all cases involving neuromuscular blocking agents Dr. Rodney emphasizes how quantitative monitoring, proper paralytic dosing, appropriate reversal agent selection, and targeting a train-of-four ratio at least 0.9 all play a key role in improving patient safety and outcomes.