'Jaws of steel' after rocuronium

Raut, Monish S; Maheshwari, Arun; Jyoti, Aman; Joshi, Sandeep

doi:10.4103/0019-5049.176275

Cited by 6 publications

(5 citation statements)

References 8 publications

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“…Although it is the known complication of drugs such as suxamethonium and volatile agents in patients having any muscular disorders or MH, but rarely it can be encountered following administration of nondepolarizing neuromuscular blocking agents like atracurium 7 , rocuronium, vecuronium or pancuronium 8 , and sedative agents like propofol, fentanyl or remifentanil [2][3][4] . Propofol or remifentanil induced muscular rigidity does not occur in completely paralysed patients 9 .…”

Section: Discussionmentioning

confidence: 99%

“…Masseter muscle spasm (MMS) can be defined as severe stiffness of the jaw with marked difficulty to open the mouth manually causing unanticipated difficulty in direct laryngoscopy and endotracheal intubation without temporomandibular joint (TMJ) dysfunction 1 . It is the known complication of drugs such as suxamethonium and volatile agents in patients having muscular disorders or malignant hyperthermia (MH), but rarely it can be encountered following administration of non-depolarizing neuromuscular blocking agents and sedative agents like propofol, fentanyl or remifentanil [2][3][4] . So it should not be limited to specific drug groups.…”

Section: Introductionmentioning

confidence: 99%

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Cis-Atracurium With Masseter Muscle Spasm: An Unanticipated Difficult Endotracheal Intubation and Temporomandibular Joint Displacement: A Case Report

Yousuf

Ahmed

Samad

2021

PAFMJ

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Masseter muscle spasm and displacement of temporomandibular joint under anaesthesia could be life threatening if an anaesthesiologist is not prepared. We present a case of 23 years old young lady, who otherwise healthy, having symptoms of abdominal pain and vomiting. Initial baseline workup showed a solitary gallstone and was then planned for urgent laparoscopic cholecystectomy. The challenges faced in the perioperative period were the management of unanticipated masseter muscle spasm and difficult endotracheal intubation after administration of cisatracurium, and temporomandibular joint displacement.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cis-Atracurium With Masseter Muscle Spasm: An Unanticipated Difficult Endotracheal Intubation and Temporomandibular Joint Displacement: A Case Report

Yousuf

Ahmed

Samad

2021

PAFMJ

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“…Succinylcholine has been associated with the adverse effect of masseter muscle rigidity even though the child was not at risk of MH [10]. Isolated masseter muscle rigidity is not a pathognomonic sign of malignant hyperthermia [6,11,12], and MMR only occurs rarely after the administration of a nondepolarizing muscle relaxant [13][14][15]. It has been documented that the first dose of succinylcholine administration can cause a decrease in heart rate but not reach the bradycardia level; however, repeated doses of succinylcholine without pre-emptive atropine administration can result in significant bradycardia [16].…”

Section: Discussionmentioning

confidence: 99%

Early Recognition and Treatment of Malignant Hyperthermia in Pediatric Patient during Bronchoscopy

Lapisatepun

Arkarattanakul

2020

Case Reports in Anesthesiology

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Malignant hyperthermia is a rare pharmacogenetic disorder triggered by depolarizing muscle relaxant and potent volatile anesthetic agents. An MH crisis is an emergency and life-threatening event requiring early recognition and prompt management. Dantrolene is the specific antagonist of MH. The authors report the case of a 9-year-old boy who underwent an emergency bronchoscopy to remove a foreign body and developed masseter rigidity after succinylcholine and sevoflurane exposure. The anesthesia team diagnosed an MH event, and the event was managed immediately with supportive treatment, dantrolene, being administered within 10 minutes. The patient survived and had a good outcome without any complications. We suggest that it is essential for anesthesia providers to recognize the need for intraoperative vigilance, prompt recognition, and treatment, and dantrolene sodium should be readily available in every hospital.

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“…However, this complication can be seen following the administration of non-depolarizing muscle relaxants such as rocuronium, vecuronium, and pancuronium (1). In this case report, we present an otherwise healthy case who suffered from masseter spasm while anesthesia did not involve common guilty drugs.…”

Section: Introductionmentioning

confidence: 99%

“…Masseter muscle rigidity is a known complication of drugs such as succinylcholine and volatile agents, especially in patients with underlying muscular diseases such as myotonia and malignant hyperthermia (MH). However, this complication can be seen following the administration of non-depolarizing muscle relaxants such as rocuronium, vecuronium, and pancuronium ( 1 ). In this case report, we present an otherwise healthy case who suffered from masseter spasm while anesthesia did not involve common guilty drugs.…”

Section: Introductionmentioning

confidence: 99%

Propofol-Induced Masseter Muscle Spasm in a Woman with a Major Depressive Disorder

et al. 2018

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Masseter muscle rigidity is a known complication of drugs such as succinylcholine and volatile agents. However, muscle rigidity is an uncommon complication of propofol. We report the case of a 56-year-old ASA-PS class I woman refereeing for colonoscopy due to chronic constipation under deep intravenous sedation. She suffered masseter spasm after the injection of propofol. Masseter spasm should not be considered limited to special drug groups. In any case of difficult mouth opening, masseter spasm should be kept in mind and deepening of anesthesia or complete blockade of neuromuscular junction should be considered by the use of non-depolarizing muscle relaxants.

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'Jaws of steel' after rocuronium

Cited by 6 publications

References 8 publications

Cis-Atracurium With Masseter Muscle Spasm: An Unanticipated Difficult Endotracheal Intubation and Temporomandibular Joint Displacement: A Case Report

Cis-Atracurium With Masseter Muscle Spasm: An Unanticipated Difficult Endotracheal Intubation and Temporomandibular Joint Displacement: A Case Report

Early Recognition and Treatment of Malignant Hyperthermia in Pediatric Patient during Bronchoscopy

Propofol-Induced Masseter Muscle Spasm in a Woman with a Major Depressive Disorder

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