Not directly anesthesia-related, but I thought this was really interesting.

So a good buddy of mine who I used to fly with works as a flight nurse still. He told me about a recent transport he did where a guy had been exposed to methyl bromide (bromomethane), which is a highly toxic pesticide that has been essentially banned throughout most of the world. The chemical exists as a colorless, odorless gas and absorption by humans is mostly through the lungs, but also skin and mucous membranes. Toxicity can develop even after brief exposure to low concentrations, and sequelae is primarily neurological, but also affects the respiratory system and can cause renal damage. NIOSH recommends that full-facepiece SCBA be used even for very brief exposure to the lowest detectable concentration, which is about 0.5ppm.

So anyway, this poor guy was unknowingly exposed. He had general malaise for most of the day and thought it was just something he ate, but someone suspected it was something serious and talked him into going to the ED. In the ED he deteriorated neurologically and developed such severe myoclonus that he had rhabdo. He was intubated and transfer was arranged.

When my buddy and his partner got there, this guy was on 65 mg per hour of midazolam and was still periodically having myoclonus so generalized that it looked like a grand mal seizure, though an EEG had apparently showed it was not. They switched him to propofol which helped, but still didn't completely abolish the myoclonus. The referring doctor told them that they had tried NMB but "it didn't work at all".....hence just being on the massive dose of midazolam.

I'm always skeptical when someone says NMB "didn't work", but who knows. I can't find anything on that and I can't really think of a mechanism wherein myoclonus would still occur but a non-depolarizer would have no effect. Maybe such massive discharge of ACH that it displaces the NMB? Destruction of the presynaptic ACH vesicles? In that case you'd expect to see cholinergic symptoms though, which I don't think were present.