Masseter Muscle Rigidity After Initiating Monitored Anaesthesia Care of Propofol and Remifentanil

Author Info

Dong Won Kim Kyu Nam Kim Jung Eun Sun Ji Hee Chang Hyun Jin Lim

Corresponding Author

Kyu Nam Kim
Department of Anesthesiology and Pain Medicine, Hanyang University Hospital, Seoul, Republic of Korea

A B S T R A C T

Masseter muscle rigidity can be seen following administration of opioids, succinylcholine, and nondepolarizing muscle relaxants. We report a case of a 56-year-old male patient in a “Cannot Intubate Cannot Ventilate Situation” due to masseter muscle rigidity after initiating monitored anaesthesia care (MAC) with remifentanil and propofol using target-controlled infusion in procedural cardiology. For rapid effect and equilibrium between plasma-concentration and effect site-concentration using target-controlled infusion, remifentanil overdose is possible during the induction period of MAC. Moreover, the presence of propofol could result in a significantly greater remifentanil concentration. To manage masseter muscle rigidity, muscle relaxants and emergent ventilation systems should be prepared to secure airway maintenance. In addition, alternative airway management devices and techniques should be on hand even if no airway difficulties are expected.

Article Info

Article Type

Case Report

Publication history

Received: Thu 02, Jul 2020
Accepted: Tue 14, Jul 2020
Published: Mon 20, Jul 2020

Copyright

© 2023 Kyu Nam Kim. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Hosting by Science Repository.
DOI: 10.31487/j.SCR.2020.07.18