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A patient in the operating room undergoes rapid sequence intubation to prevent aspiration of gastric contents. During this rapid induction, he is given a standard intravenous (IV) dose of muscle relaxant "X." The patient is then given a standard IV dose of vecuronium to maintain muscle relaxation during surgery. At the end of the surgical procedure, more than an hour later, the anesthesiologist administers a standard IV dose of neostigmine. However, the patient does not respond and continues to display too much muscle paralysis to permit safe extubation. Drug X was most likely which of the following?

A. Dantrolene
B. Pancuronium
C. Succinylcholine
D. Midazolam
E. Tubocurarine

I heard USMLE testing more anesthesia qns so I got this one for you to practice....
Sorry, but I don´t get this qs.

I understand that drug X is Succi...but he only received one dose of succi, so we are not in phase II block. He received Vecuronium, which means that the muscular response (twitch) came back (the cholinesterases were functioning ok) - you always have to check the twitches first......So, why he still have muscle paralysis ... the only thing that I can think of is that the patient received Pancuronium instead of vecuronium (standard IV dose of neostigmine after one hour is not enough) :eek:
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