My apologies if this has been covered here before. I asked an experienced provider if we really needed to reverse our patient before extubation. Response: student, we always give full reversal. Others have told me that it's safe practice to give just a small dose to CYA. I wanted to discuss this idea because I've read conflicting data. Hope you guys could elucidate for me.

Background: Surgeon did not want paralysis, just wanted to let MR wear off. Pt had all 4 twitches shortly after incision after 40 mg of Roc given to 120 kg patient during intubation. Surgery was 2 hours, 20 minutes and no additional doses of MR given. At emergence, TOF 4 very strong twitches. RR 15-16 with TVs 400-500 mL. Pt was going home, male age 50, no intra-op foley (worried about urinary retention). I've read that giving neostigmine to a fully recovered patient may decrease TVs and upper airway muscle activity, if TOF >0.9. (Brull SJ, Murphy GS. Residual neuromuscular block: lessons unlearned. Part 2: Methods to reduce the risk of residual weakness. Anesth Analg 2011;111:129-40.)