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Many drugs can impact nondepolarizing muscle relaxants (NDMRs), leading to prolonged or enhanced neuromuscular blockade. Long-term use of antiepileptic drugs (AEDs) such as carbamazepine, phenytoin, and valproic acid has been reported to be associated with resistance to both the aminosteroidal (eg, rocuronium, vecuronium) and benzylisoquinolinium (eg, atracurium, cisatracurium) NDMRs. 1–10 Reports on the effects of newer AEDs (eg, lamotrigine, levetiracetam) on rocuronium are scarce and may not be well recognized. Herein, we report a case of delayed

occurred 8 times over the course of the past year. In 2011, stiripentol, a GABA-ergic antiepileptic drug with a specific FDA indication for DS when coadministered with clobazam, and levetiracetam were recommended as new antiepileptic drugs that could be efficacious in shortening convulsive seizures of longer duration and avoiding SE in DS. 1 A recent article showed that a cytochrome P450 isoform inhibitor was effective as an adjunct to existing antiepileptic drug treatments. 8 A major problem with anesthesia for patients with DS is the regulation of body

subsequently developed and have proven useful for chronic pain. These include tiagabine (Gabitril), topiramate (Topamax), and pregabalin (Lyrica), which all have GABA-ergic and for some, other pharmacodynamic effects such as inhibition of calcium channels. Many of these agents are also used off-label by psychiatrists for anxiety and bipolar disorders. Lyrica is the only drug FDA-approved for fibromyalgia. The mechanism of levetiracetam (Keppra), another newer agent, is not known. Common to these newer agents is the lack of serious adverse effects such as was seen with the

not. CASE REPORT The patient was a 5-year-old girl (height 115.9 cm, weight 24 kg, body mass index 17.9 kg/m 2 ) with a history of intellectual disability, CILF, and epileptic seizures. The patient's seizures reportedly occurred rarely and were well controlled with levetiracetam (250 mg, twice daily), which was continued perioperatively. The patient had no known drug allergies and had undergone intubated general anesthesia without complications twice in the past. Because of her intellectual disability, she was unable to speak meaningful