A surgeon′s assessment of inadequate neuromuscular antagonism in a case of prolonged neuromuscular blockade

Abstract

Evaluation of the degree of neuromuscular blockade by the surgeon using clinical criteria alone is unreliable. We report a case of prolonged neuromuscular blockade lasting 5.5 h, where an additional intra-operative dose of neuromuscular relaxant was given at the request of the surgical team. Possible causes of prolonged neuromuscular antagonism are discussed, as is the importance of neuromuscular assessment prior to the administration of additional neuromuscular blocking agents when receiving a surgeon request for additional neuromuscularblockade.

Interdisciplinary intraoperative communication and collaboration needed for optimal neuromuscular blockade management

“…We would like to thank Dr. Lamberg and Dr. Answine for their case report, “ A surgeon's assessment of inadequate neuromuscular antagonism in a case of prolonged neuromuscular block. April-June 2013 29(2):244-247.”[ 1 ] In this case an additional 10 mg dose of neuromuscular blocking agent (NMBA) was given 75 min after an intubation dose of rocuronium at the request of a surgeon based on “feel” of the surgical site during a hemicolectomy on an 82-year-old 74 kg woman. Although it is unusual that this patient's neuromuscular blocking (NMB) lasted as long as it did (5.5 h), the preceding scenario is typical.…”