In their recent article, Fuchs-Buder et al [1] echoed unfounded concerns regarding our meta-analysis [2] that had been initially raised by others [3]. Fuchs-Buder and colleagues chose to ignore our detailed rebuttal [4], which we will reiterate in brief here. They claimed that we made no distinction between objective and non-objective monitoring methods in our meta-analysis. This is incorrect. We found no evidence supporting the hypothesis that the use of quantitative neuromuscular function monitors is superior to conventional monitors in reducing the incidence of postoperative residual curarization (PORC) [4]. We also stressed that 'The issue is not which type of monitor (conventional or quantitative) is used, but appears to be who is using the monitor. What makes the difference in the incidence of PORC is not the monitor but the anaesthetist behind the monitor.'

The second concern echoed by Fuchs-Buder et al relates to the inclusion of comparative and non-comparative studies in our meta-analysis. As we indicated in our rebuttal [4], using very narrow inclusion criteria would result in more homogenous data at the cost of excluding valuable studies, introducing bias, and making the data less generalisable [5]. Horlocker and Brown [6] stated 'Clinical questions pertinent to the practice of anaesthesiology frequently do not meet criteria for high-level evidence as judged by evidence-based medicine advocates.' Without meta-analysis, heterogeneity and weight cannot be determined, and they definitely cannot be determined by simple categorization and data description.

There are two sides to every coin. In science, one should present both sides regardless of his or her opinions. Fuchs-Buder et al failed to present both sides of the issue. Presenting selective text to enforce one’s opinion is biased and invalidates the basic core of science.

Mohamed Naguib

Aaron A. Kopman

References

1. Fuchs-Buder T, Schreiber J-U, Meistelman C. Monitoring neuromuscular block: an update. Anaesthesia 2009; 64 (Suppl. 1): 82–9.

2. Naguib M, Kopman AF, Ensor JE. Neuromuscular monitoring and postoperative residual curarisation: a meta-analysis. Br J Anaesth 2007; 98: 302-16.

3. Viby-Mogensen J, Claudius C, Eriksson LI. Neuromuscular monitoring and postoperative residual curarization. Br J Anaesth 2007; 99: 297.

4. Naguib M, Kopman AF, Ensor JE. Neuromuscular monitoring and postoperative residual curarization. Br J Anaesth 2007; 99: 297-9.

5. Gotzsche PC. Methodology and overt and hidden bias in reports of 196 double-blind trials of nonsteroidal antiinflammatory drugs in rheumatoid arthritis. Control Clin Trials 1989; 10: 31-56.

6. Horlocker TT, Brown DR. Evidence-Based Medicine: haute couture or the emperor's new clothes? Anesth Analg 2005; 100: 1807-10.