Can someone help explain the physiology or interaction between a pt taking Dilantin and action of NDMR involved in muscle relaxation. I had a pt that I was trying to have two twitches or less as per my CRNA. I was having a difficult time with keeping twitches suppressed (2). I had to give a total of 27mg of Vec. over 3 hours case. The pt was at 0.75 ET% of Iso. No curare clefts but pt was having a lot of movement. I am thinking that the surgeon was stimulating the motor cortex/homunculus. The pt had history of seizures but no real changes in V.S. After the case, (reversed), upon waking up the pt had a full body rhytmic jerking. I was told to look at the pupils- both midline and 3mm. The pt finished this episode, started following commnands and we removed the tube (no postictal state). I was curious if there is a good site or explanation. Thanks