Assessment of Neuromuscular Function in Patients With Prior Cosmetic Procedures: A Case Report

Area of Science:

• Anesthesiology
• Neurology
• Plastic Surgery

Background:

• Botulinum toxin type A (Botox) is frequently used for cosmetic purposes.
• Patients often do not report prior Botox use, leading to incomplete medical records.
• This omission can compromise the accuracy of neuromuscular function testing.

Observation:

• A patient undergoing mechanical ventilation experienced inadequate neuromuscular blockade despite facial nerve stimulation.
• Facial nerve testing suggested sufficient paralysis, but patient-ventilator asynchrony persisted.
• Peripheral nerve stimulation was relocated to the ulnar nerve, revealing muscle twitches indicative of inadequate blockade.

Findings:

• Facial nerve stimulation can be unreliable for assessing neuromuscular blockade in patients with a history of cosmetic Botox.
• Ulnar nerve stimulation provided a more accurate measure of neuromuscular function in this case.
• Previous Botox injections can alter the response to neuromuscular blockade monitoring.

Implications:

• Healthcare providers must inquire about and document cosmetic Botox use.
• Ulnar nerve monitoring is recommended for patients with a history of cosmetic Botox procedures.
• Accurate neuromuscular blockade assessment is vital for safe mechanical ventilation and patient outcomes.