TY - JOUR
AR - SCR-2020-7-118
TI - Masseter Muscle Rigidity After Initiating Monitored Anaesthesia Care of Propofol and Remifentanil
AU - Dong , Won Kim
AU - Kyu Nam, Kim
AU -  Jung , Eun Sun
AU - Ji Hee , Chang
AU - Hyun , Jin Lim
JO - Surgical Case Reports
PY - 2020
DA - Mon 20, Jul 2020
SN - 2613-5965
DO - http://dx.doi.org/10.31487/j.SCR.2020.07.18
UR - https://www.sciencerepository.org/masseter-muscle-rigidity-after-initiating-monitored-anaesthesia-care-of-propofol_SCR-2020-7-118 
KW - Masseter muscle rigidity, remifentanil, target-controlled infusion
AB - 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.