• Hubert J Schmitt.
• Department of Anaesthesia, Friedrich-Alexander University Erlangen-Nuremberg, Krankenhausstrasse 12, D-91054, Erlangen, Germany. hubert.schmitt@kfa.imed.uni-erlangen.de.
• BMC Anesthesiol. 2018 Jul 11; 18 (1): 82.

BackgroundDuring anaesthesia it is not uncommon to administer epinephrine in patients blocked by non-depolarizing muscle relaxants. However, there are few reports on possible interaction of epinephrine with neuromuscular transmission in humans.Case PresentationAn otherwise healthy 74-yr-old man underwent transurethral resection of a benign prostatic hyperplasia under total intravenous anaesthesia. Because of repeated drop in heart rate and blood pressure the patient received in total three bolus of epinephrine 5 μg, respectively. Each time this small dose of epinephrine intensified a rocuronium-induced neuromuscular block verified by acceleromygraphy. Further anaesthetic course was uneventful.ConclusionsIn this case reported here small doses of intravenously administered epinephrine markedly prolonged a rocuronium-induced neuromuscular block. Given the widely used co-administration of epinephrine and muscle relaxants possible adrenergic interference with neuromuscular transmission would have implications for daily anaesthetic practice.

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