Muscle Relaxants — Depolarising and Non-depolarising

A 58-year-old male with a history of myasthenia gravis (MG) is scheduled for elective cholecystectomy. During induction, propofol and remifentanil are used. For muscle relaxation, a non-depolarising agent is chosen. Thirty minutes into surgery, the neuromuscular monitoring shows a train-of-four (TOF) ratio of 0.35 (moderate blockade). The surgeon requests deeper relaxation. The patient's last dose of pyridostigmine was 8 hours ago. What is the most appropriate next step?

A 35-year-old male patient is scheduled for emergency laparotomy for acute abdomen. Induction is with propofol and fentanyl. During intubation, succinylcholine 1.5 mg/kg IV is administered. Within 30 seconds of drug administration, the patient develops severe muscle rigidity, trismus, and masseter muscle spasm. Core temperature begins to rise. What is the most appropriate immediate management?

A 48-year-old female patient with rheumatoid arthritis (on chronic corticosteroids) is undergoing elective hip arthroplasty. After induction with propofol and remifentanil, rocuronium 0.6 mg/kg IV is given for intubation. Intubation is achieved easily. At the end of surgery (120 minutes later), train-of-four (TOF) monitoring shows 2 out of 4 twitches. The anaesthetist plans to reverse the neuromuscular blockade. Which agent is most appropriate and why?

Regarding the pharmacology of depolarising and non-depolarising muscle relaxants, all of the following statements are TRUE EXCEPT:

A 35-year-old male patient is undergoing elective abdominal surgery under general anesthesia. After induction with propofol and fentanyl, succinylcholine 1.5 mg/kg IV is administered for rapid sequence intubation. Five minutes post-intubation, the patient develops severe hyperkalemia (K⁺ 7.2 mEq/L), masseter muscle rigidity, and a core temperature of 38.5°C. The surgeon requests to proceed with surgery. What is the most appropriate immediate next step?