Key result
Chronic donepezil therapy linked to intraoperative atracurium resistance requiring multimodal anesthesia.
Case Report (n=1)
No
Chronic use of the acetylcholinesterase inhibitor donepezil can cause intraoperative resistance to non-depolarizing neuromuscular blockers like atracurium, necessitating individualized, potentially opioid-free anesthetic planning in geriatric patients.
May indicate donepezil-atracurium interaction in geriatrics; hypothesis-generating and requires prospective validation before practice implications.
We report the case of an 84-year-old male with dementia on chronic donepezil therapy who demonstrated resistance to the non-depolarizing neuromuscular blocker atracurium during general anesthesia for orthopedic surgery. Anesthesia was successfully managed using multimodal, opioid-free techniques. The case highlights an interaction between an acetylcholinesterase inhibitor and a neuromuscular blocking agent, emphasizing the need for awareness of such interactions in elderly patients. It also underscores the importance of conducting a preoperative medication review and individualized anesthetic planning in geriatric populations.
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Niruba et al. (2025) conducted a case report in Dementia and right humerus fracture (n=1). Donepezil was evaluated on Intraoperative resistance to atracurium. An 84-year-old male on chronic donepezil therapy demonstrated intraoperative resistance to the non-depolarizing neuromuscular blocker atracurium, requiring management with multimodal, opioid-free anesthesia.
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