The weak patient in recovery — residual neuromuscular blockade

Presentation

A 68-year-old woman is in the recovery room after a 90-minute abdominal operation performed under a rocuronium-based general anaesthetic, reversed at the end with neostigmine 2.5 mg and glycopyrrolate. She is awake, opens her eyes and obeys commands, and can lift her head briefly on request. The recovery nurse reports, however, that she is "floppy," her breathing is shallow, and her oxygen saturation has drifted to 92 per cent on room air. She received no intra-operative neuromuscular monitoring.