Recently, I was doing a total abdominal hysterectomy on a 100kg patient. She was very heavy up top, supine with mild trendelenburg position was requested by surgeon. The surgeon also requested "maximum paralysis". After induction using Roc and Sux, Vec 5 mg was given. Of course before the Vec was dosed all twitches were back, so I proceeded to give the Vec of 5 mg. After checking twitches every 15 minutes and getting no response, surgeon continues to complain of patient "pushing" on him. Fentanyl was bolused throughout also. Patient was on pressure control ventilation and pulling about 550-600 TV with peak pressure 35-40. Throughout case, no twitches returned and Vec 10mg along with fentanyl 500mcg was the total dosage towards end of case. Surgeon still complains of patient "pushing". The CRNA I was with said it is probably the vent "pushing" trying to ventilate this top heavy lady in trendelenburg. So of course when surgeon is done, it's about 45-60min before we leave the OR. Has anyone else had this problem? Is there any research on pleasing the surgeon at the same time as not overdosing your muscle relaxant? I've been trying to find some research articles on this but am having no luck.

Lacy, SRNA