• Andre Dos Santos Rocha, Marco Betello, Argyro Nikolaou, Roberta Südy, Gergely Albu, and Eduardo Schiffer.
• From the Division of Anaesthesiology, Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland (ADSR, MB, RS, GA, ES), Department of Anaesthesia, Northern Lisbon University Hospital Centre, Lisbon, Portugal (ADSR), University Clinic of Anesthesiology and Reanimation, Faculty of Medicine, University of Lisbon, Portugal (ADSR), Division of Clinical Pharmacology and Toxicology, Department of Anaesthesiology, Pharmacology and Intensive Care, University Hospitals of Geneva, Geneva, Switzerland (AN).
• Eur J Anaesthesiol. 2025 Jan 1; 42 (1): 737673-76.

AbstractResistance to the effects of rocuronium and other neuromuscular blocking agents (NMBA) has been previously reported, including delayed onset of relaxation, rapid recovery and incomplete paralysis under recommended doses. These conditions have been associated with denervation injury, burns, immobilisation, infections, metabolic disorders, and drug interactions. In this report, we describe the case of a young male without any known pre-disposing factor for NMBA resistance, who failed to attain muscle relaxation with non-depolarising NMBA despite high doses of rocuronium and atracurium during two surgeries for colorectal cancer, several months apart. Investigations for drug failure and genetic testing did not indicate a plausible cause. After chemotherapy and tumour resection, the patient underwent a third surgical procedure under general anaesthesia with normalised NMBA response. Patient's written consent was obtained for publication.Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the European Society of Anaesthesiology and Intensive Care.

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