Expert: Arjav Shah, M.D. - 1/25/2012

Question
Hello,
My mother went in for surgery 2 days ago. She had a Functional Endoscopic Sinus Surgery, Septoplasty with turbinate reduction. She was out of surgery at 12pm, but did not begin to wake up until about 230pm. She could not really wake up, nor move her extremities, and she stated that they felt numb. The attending anesthesiologist said that she was given rocuronium and that some people are more sensitive to it. He gave her some counter acting drugs, but she still could not move much more then wiggle her fingers and toes.
It is now 2 days after surgery and she continues to have extreme difficulty moving her extremities or even lifting her head. I understand the anesthesia should have worn off by now, so are the drugs what is causing this, or possibly something else?
She is being seen by ENT residents, who are not very helpful, Anesthesia, and today a Neurologist came.
She states that today she can feel the cold and pokey sensation from the Neurologist, but is still unable to move very much.
The Neurologist ordered an MRI of her head and neck, because she broke her neck 20 years ago, and my speculation is that they think her hear/neck wasn't supported properly in surgery, or something?

She is a 50 year old female.
Iodine, Latex, Gluten allergies.
No history of high or low blood pressure, diabetes, cancer.
She takes Zoloft 250mg, Singulair 10mg, Folic Acid 1mg and Multivitamins.
Location: Denver, Colorado

Answer
This is a very distressing situation. While I regret that I may not have the definitive answer or treatment for you mother's condition, perhaps clarifying the situation for you will alleviate some of your apprehension and make you a more informed participant.

There's probably two separate issues here. If I understand correctly, she was slow to "wake up." It is certainly possible that non-paralyzing medications...like narcotic pain medicines, sedatives, and even anesthetic gases...could delay a patient's wakefulness/responsiveness for a couple of hours postoperatively. Rocuronium, on the other hand, does paralyze the muscles. Despite the documented pharmacology of the medication, it has been known to have a prolonged effect in some patients. Prolonged, meaning an additional hour or two.

But the more concerning issue is the persistent symptoms in the arms and legs. In the absence of serious liver or kidney disease, it is highly improbable that any of the drugs your mother received in the operating room led to the numbness and weakness.  That all four extremities are involved, and breathing is not apparently impaired, raises the suspicion that there is some pathology in the cervical (neck) spine. It would be difficult for me to speak to the cause of such pathology, although neck positioning during surgery is one possibility. An MRI or CT of the neck is a reasonable diagnostic step. Likewise, nerve conduction and electromyography studies may be performed.

It is also reasonable for a neurologist to be involved in your care at this point. Unless the diagnostic studies demonstrate some significant fracture in the neck or other surgically correctable problem, I expect that your consultant's will tell you that only time will permit your mother's neurologic function to recover.

Be strong, be informed, be involved, and be faithful.