Masseter muscle rigidity: Atypical malignant hyperthermia presentation or isolated event?

Abstract

This report describes a case of masseter muscle rigidity encountered at the start of an elective gynaecological procedure. At preoperative assessment, the patient, a 41-year old woman with a previous non-eventful surgical and anesthetic history was given a Mallampati score of 3. Following suxamethonium administration, full mouth opening proved difficult. Laryngoscopy and tracheal intubation were not possible leading to the eventual use of a laryngeal mask airway and resulting in a successful anaesthetic outcome. A number of possibilities that may account for this situation as well as viable options for airway access in such cases are discussed below.

Controversies in Pediatric Perioperative Airways

“…Another conflicting issue is the use of suxamethonium in childhood. According to the Food and Drug Administration (FDA) recommendations, suxamethonium should be reserved only for emergency situations due to published adverse events and even deaths both in pediatric patients [ 51 – 53 ] and in adults [ 54 – 57 ]. Should we all abandon suxamethonium in pediatric anesthesia as it can be seen in some centers [ 58 ]?…”

Succinylcholine induced Masseter spasm in a young male with frontal sinus abscess

“…Initially endotracheal intubation can be attempted, failure of which must be followed up with other alternatives like nasotracheal intubation, LMA or retrograde endotracheal intubation. Surgical management involves cricothyroidotomy or tracheostomy which can be considered only as a last resort 4,5 but in our patient, laryngoscopy was not possible so bag-mask ventilation was started to buy time. After about 5 more minutes laryngoscopy was re attempted and with the use of millers blade we were able to intubate the patient with a 7.0 cuffed E T tube prior to deepening the plane of anesthesia with bolus dose of dexmedetomidine and Propofol.…”

Succinylcholine-Induced Masseter Muscle Rigidity Successfully Managed With Propofol and Laryngeal Mask Airway: A Case Report and Brief Review

“…Surgical cricothyroidotomy and tracheostomy can be engaged as a last resort [6]. The use of LMA as a safe method to secure the airway is well documented [5]. In our patient, laryngoscopy was impossible so bag-mask ventilation was started to buy time.…”

“…MMR can be an independent occurrence or it can be an early manifestation of MH. MH is the most feared complication as it is invariably fatal if not managed in time [5]. Table 1 shows different anesthetic agents that can trigger MH [1].…”