C_2025_Cureus_17_e86801

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.