Always Check the Muscle Twitch: Residual Neuromuscular Block After Removal of a Gastric Balloon. Christian Bohringer, MBBS, and Sharon Ashley, MD. | November 30, 2023

https://psnet.ahrq.gov/web-mm/always-check-muscle-twitch-residual-neuromuscular-block-after-removal-gastric-balloon In this WebM&M Case, a 38-year-old woman with class 3 obesity required removed of a gastric balloon under general anesthesia. She required a relatively large dose of rocuronium for endotracheal intubation, and she was given intravenous sugammadex (200 mg) at the end of the procedure to reverse the neuromuscular block. A quantitative neuromuscular block monitor was not used, but reliance was placed on clinical signs. Shortly after arrival in the post-anesthesia care unit, she couldn’t move or open her eyes and became jittery with low oxygen saturation. Quantitative blockade monitoring revealed a train of four (TOF) ratio less than 70%, so she was given another 200 mg of intravenous sugammadex with return of normal motor function.