Case presentation

A 53-year-old man was admitted to hospital for elective repair of a descending aortic dissection and type B intramural haematoma. He had a history of stage 3 chronic kidney disease and took aspirin for paroxysmal atrial fibrillation. At 07:00 on the morning of the operation he was awake, alert and moving all limbs. His surgery began at 09:10. He received various anaesthetic medications, including rocuronium 50 mg (0.5 mg/kg); last dose at 17:20. The surgical repair ended at 16:15, and left the operating theatre at around 20:00 after an uneventful surgery.

At midnight, he was still unresponsive despite receiving naloxone. His observations were: temperature 37°C, blood pressure 158/100 mmHg, heart rate 80/min, intubated and breathing at set respiratory rate 14/min, and oxygen saturation 100% on pressor support of 8 cmH₂O, tidal volume 580 mL (8 mL/kg of his ideal body weight), FiO₂ 45%, and positive end-expiratory pressure of 5 cmH₂O. He was not on sedation. His pupils were …