The silent lung that occurs during the perioperative period is characterized by rapid onset, rapid progression, and high mortality. This article reports a case of a 62-year-old patient with a left lower lung nodule who underwent lower lung segmentectomy under thoracoscopy and was assisted with tracheal intubation using rocuronium. 21 minutes after the first administration, the patient presented with increased airway pressure, difficult ventilation, a "steel lung" feel, and symptoms similar to silent lung. Subsequently, 80 mg of methylprednisolone and 50 μg of epinephrine (in divided doses) were injected intravenously, but no relief was observed, and the blood oxygen saturation decreased to 38%. In this case, after giving another 1 mg of epinephrine, the airway pressure gradually decreased to 33 cmH₂O, and the blood oxygen saturation gradually increased. Considering that airway spasm might be caused by multiple intubation stimulations, additional rocuronium bromide was added to allow for reintubation. However, the patient again experienced increased airway pressure and difficulty in ventilation prior to intubation. The clinical pharmacist conducted a correlation evaluation of this adverse event and considered the result as possible. The mechanism, rescue and prevention of silent lung induced by rocuronium was also discussed in the case report. A thorough anesthesia assessment should be conducted prior to surgery, and an appropriate anesthesia induction plan should be formulated. Once an adverse event occurs, it should be promptly identified and treated.

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