Prolonged residual paralysis after a single intubating dose of rocuronium

It is often argued that neuromuscular monitoring is unnecessarywhen only one dose of an intermediate-acting neuromuscular blockingagent is given. This case report documents that it may takemore than 3.5 h before it is possible to antagonize a blockcaused by a normal dose of rocuronium (0.6 mg kg^–1). Possiblecauses of the extremely prolonged duration of action are discussed,as is the importance of quantitative neuromuscular monitoring.