Effect of SIRS, Sepsis and Chemotherapy on Rocuronium Muscle Relaxation: A Case Series and Literature Review

Background: Studies have shown that systemic inflammatory response syndrome (SIRS), sepsis and chemotherapy can attenuate the muscle relaxing effect of rocuronium, prolong the onset of muscle relaxation as well as shorten the maintenance and recovery time. However, there are few reports on this phenomenon. Case presentation Case 1 was a 47-year-old Chinese male with gastric remnant cancer, who had a sudden onset of abdominal pains after SOX chemotherapy, and underwent an emergency abdominal CT suggesting gastrointestinal perforation. An emergency abdominal exploratory surgery was performed, after which the intraoperative recovery of spontaneous breathing and abdominal muscle tension occurred several times. Case 2 was a 71-year-old Chinese male who underwent an emergency borehole drainage for a sudden cerebral hemorrhage. His intraoperative mechanical ventilation mode showed multiple respiratory waveform changes, which were considered as the recovery of spontaneous breathing. Case 3 was a 43-year-old Chinese female diagnosed with breast cancer, who underwent a radical elective breast cancer surgery after a chemotherapy through the AC-T regimen. Intraoperatively, a significant muscle fibrillation was developed during lymph node dissection. Conclusion Systemic inflammatory response syndrome (SIRS), sepsis and chemotherapeutic factors could be associated with a poor effect of intraoperative rocuronium muscle relaxation, whose specific mechanisms need to be further clarified.