Neuromuscular block monitoring in patients with facial rejuvenation: A case report
Jahromi B, Knezevic NN. Neuromuscular Block Monitoring in Patients With Facial Rejuvenation: A Case Report. A A Pract. 2020;14(13):e01334. doi:10.1213/XAA.0000000000001334
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.