Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2020 Nov;14(13):e01334.
doi: 10.1213/XAA.0000000000001334.

Neuromuscular Block Monitoring in Patients With Facial Rejuvenation: A Case Report

Behdad Jahromi  1 , Nebojsa Nick Knezevic  1   2
Affiliations
Case Reports

Neuromuscular Block Monitoring in Patients With Facial Rejuvenation: A Case Report

Behdad Jahromi et al. A A Pract. 2020 Nov.

Abstract

Neuromuscular blocking agents are used during general anesthesia to optimize intubating and surgical conditions. Determining the level of neuromuscular blockade and ensuring adequate reversal are crucial to prevent anesthesia-related postoperative residual weakness and its associated complications. We present a 33-year-old woman who underwent laparoscopic appendectomy. Facial nerve stimulation failed to elicit response to neurostimulation, but subsequent ulnar nerve stimulation showed train-of-four count of 4 without fade in the adductor pollicis muscle. It was later determined that the patient recently received botulinum toxin treatment. Facial nerve stimulation is not a reliable method for neuromuscular blockade monitoring.

PubMed Disclaimer

References

    1. Blobner M, Frick CG, Stäuble RB, et al. Neuromuscular blockade improves surgical conditions (NISCO). Surg Endosc. 2015; 29:627–636
    1. Naguib M, Brull SJ, Kopman AF, et al. Consensus statement on perioperative use of neuromuscular monitoring. Anesth Analg. 2018; 127:71–80
    1. Hemmerling TM, Schmidt J, Hanusa C, Wolf T, Schmitt H. Simultaneous determination of neuromuscular block at the larynx, diaphragm, adductor pollicis, orbicularis oculi and corrugator supercilii muscles. Br J Anaesth. 2000; 85:856–860
    1. Donati F, Meistelman C, Plaud B. Vecuronium neuromuscular blockade at the diaphragm, the orbicularis oculi, and adductor pollicis muscles. Anesthesiology. 1990; 73:870–875
    1. Brull SJ, Silverman DG. Pulse width, stimulus intensity, electrode placement, and polarity during assessment of neuromuscular block. Anesthesiology. 1995; 83:702–709

Publication types

LinkOut - more resources