I Gave Rocuronium 3 Hours Ago, Do I Need to Reverse?

Abstract

A 58-year-old woman with chronic low back pain secondary to nerve impingement presents for lumbar laminectomy and fusion. The patient has a history of coronary disease treated with a stent 3 years ago, as well as obesity and moderate chronic obstructive pulmonary disease (COPD) from smoking. Transcranial motor evoked potential monitoring will be performed during the procedure to assess motor function, so neuromuscular blocking drugs cannot be given during the case. One dose of rocuronium, 30 mg, is given at the surgeon’s request to aid the initial dissection, and no further muscle relaxation is administered for the rest of the operation. Three hours later, the patient is breathing spontaneously with good tidal volumes, seemingly ready for extubation. Your attending walks in and asks if the patient has been reversed.