Possible augmentation of neuromuscular blockade by propofol during recovery from rocuronium.

Propofol is a widely used drug in anesthesia practice, and its pharmacological characteristics are well known. However, propofol is not known for neuromuscular effects. As part of clinical neuromuscular monitoring, the neuromuscular responses to train-of-four (TOF) stimulation were monitored and recorded. We observed, in two cases of balanced anesthesia maintained by desflurane and fentanyl, that administration of a small dose of propofol during almost complete recovery from rocuronium in two patients resulted in marked decreases of both T1 (first twitch response of the TOF) and the TOF ratio. This neuromuscular block dissipated in both patients without any subsequent neuromuscular effects. These two observations provide visual confirmation of the possible impact of propofol on recovery from a rocuronium neuromuscular blockade.