Sensitivity to both vecuronium and neostigmine in a sero-negative myasthenic patient

We describe a sero-negative ocular myasthenic patient who showed exaggerated responses to both vecuronium and neostigmine. These hypersensitive responses were not anticipated because preoperative clinical and laboratory evaluations suggested a negligible impairment of somatic muscles by myasthenic processes. This case report re-emphasizes that, if neuromuscular blocking agents and their antagonists are administered to myasthenic patients, regardless of the degree of impairment, the dose should be titrated carefully with the aid of a neuromuscular transmission monitor.