A patient is extubated after a 3-hour laparoscopic surgery with rocuronium for neuromuscular blockade. At 6 hours post-extubation, the patient complains of difficulty lifting the head off the bed and has weak grip strength. Train-of-four monitoring at the adductor pollicis was not performed. The most likely diagnosis is:

• A Residual neuromuscular blockade (incomplete reversal) ✓
• B Postoperative residual curarization from phase II block
• C Recurarization from volatile anesthetic accumulation
• D Critical illness polyneuropathy

Explanation

Residual neuromuscular blockade after rocuronium without objective TOF monitoring is the most likely cause of postoperative weakness. A TOF ratio below 0.9 at the adductor pollicis is associated with pharyngeal dysfunction and aspiration risk. Phase II block is specific to succinylcholine, not rocuronium. Objective monitoring should be used to guide reversal and confirm adequate recovery before extubation.

Reference: Miller's Anesthesia, 9th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.