# Intraoperative Resistance to Atracurium in a Geriatric Patient on Donepezil: A Case Report

## TL;DR

An elderly patient on donepezil showed resistance to atracurium during surgery, highlighting the need for careful medication review in older adults.

## Contribution

Reports a rare interaction between donepezil and atracurium in geriatric anesthesia.

## Key findings

- An 84-year-old patient on donepezil showed resistance to atracurium during surgery.
- Multimodal, opioid-free anesthesia was successfully used as an alternative.
- The case emphasizes the importance of preoperative medication review in elderly patients.

## Abstract

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.