Postoperative Residual Curarization: A Case Report

An elderly frail male with a history of liver disease presented for a laparoscopic ablation of a liver mass. Nondepolarizing neuromuscular blockade agents were utilized to maintain a train-of-four count of 1 to 2 twitches throughout the surgery. At the conclusion of the operation the patient’s neuromuscular blockade was assessed via train-of-four at the corrugator supercilii and the patient was given neuromuscular blockade reversal agents. Approximately 10 minutes after arrival to the recovery unit, the patient presented with symptoms suggestive of postoperative residual curarization. This case report demonstrates the importance of objective assessment strategies when evaluating neuromuscular blockade. Monitoring twitches at the adductor pollicis at the end of surgery gives the practitioner better evidence of a more complete neuromuscular blockade recovery. Dosing and timing of neuromuscular blockade reversal agents is especially prudent to assure adequate patient recovery and safety postoperatively.