Are There Rocuronium Rapid Metabolizers? A Case Report on the Importance of Neuromuscular Monitoring

Abstract

A healthy 34-year-old female was scheduled for laparoscopic hysterectomy and adnectomy under general anesthesia, combined with an epidural catheter. Throughout surgery, she required and received unusual high doses of rocuronium in unusual short intervals (1mg/kg/h) to maintain adequate neuromuscular block as confirmed by continuous neuromuscular monitoring. Also, despite a functioning epidural catheter, the patient required high doses of remifentanil. This case emphasizes the importance of neuromuscular monitoring in every patient receiving neuromuscular blocking agents. It also raises the question if there are unknown influences or different mechanisms of metabolism.