Case Report: Resistance to Neuromuscular Blockade and the Benefits of Quantitative Monitoring

Neuromuscular blockade (NMB) monitoring is essential in modern anesthetic practice, particularly for optimizing the administration of blocking agents and their reversal agents. We present the case of a 54-year-old female patient with a history of chronic carbamazepine use and monoplegia, who underwent a laparoscopic cholecystectomy. Despite the administration of standard and additional doses of rocuronium, significant resistance to NMB was observed, along with difficulty maintaining the surgical field, as confirmed by quantitative monitoring. The patient showed rapid recovery from the blockade without the need for reversal agents, highlighting the crucial role of continuous monitoring in intraoperative decision-making. This case underscores the importance of considering factors such as anticonvulsant use and neurological disorders in NMB response and emphasizes the impact of quantitative monitoring in resource-limited settings to enhance perioperative safety and outcomes.