Donepezil-related inadequate neuromuscular blockade during laparoscopic surgery: A case report

Figure 1 Progress of the train-of-four ratios and counts from the start of total intravenous anesthesia with propofol and remifentanil. After a bolus injection of rocuronium 50 mg (0.9 mg/kg), the train-of-four (TOF) ratio decreased at an unusually slow rate. When a TOF count of 0 was detected approximately 7 min later, endotracheal intubation was performed. A TOF count of 1 was detected within 1 min, and a TOF ratio of 12% was detected within 2 min. A TOF count of 4 was continuously detected even with an additional bolus and continuous infusion of rocuronium. A TOF count of 0 was achieved after the conversion of total intravenous anesthesia to inhalation anesthesia with cisatracurium 6 mg. Solid black lines represent TOF count (0-4); red dots represent TOF ratio (%). Roc: Rocuronium; Cis: Cisatracurium; TOF: Train-of-four; OP: Operation.