Masseter Spasm After Pancuronium

The Clarus Video System (Trachway) intubating stylet for awake intubation

“…We consider that manikin-based research is an absolutely necessary first-line research exercise to obtain initial information on a newly introduced device [5,6], as this does not expose patients to unnecessary risk. Only when devices have been shown to have a similar performance to other established devices in manikins should they then be used in clinical trials on patients.…”

“…The Pentax Airway Scope (AWS; Pentax Corporation, Tokyo, Japan) has been used to aid tracheal intubation in a patient wearing a halo vest [5]. The Trachway intubating stylet has the advantage of providing direct observation during intubation and can therefore avoid blind and potentially traumatic airway manipulation.…”

“…Any muscular rigidity due to propofol or remifentanil does not occur in completely paralysed patients [1,2]. Masseter muscle spasm can occur following administration of non-depolarising neuromuscular blocking drugs [3][4][5], but all of these cases completely resolved following recovery or reversal of the blockade. One previous report described a patient who developed masseter spasm following propofol and remifentanil induction without the use of neuromuscular blocking drugs [6].…”

Delayed-onset malignant hyperthermia in association with rocuronium use

“…[10][11][12][13] Polta et al 10 described the development of isolated masseter-muscle spasm-a common finding in patients experiencing malignant hyperthermia and a risk factor for the development of the disorder-after the administration of pancuronium in a 20-year-old man undergoing corrective surgery for congenital aortic stenosis 2,10 ; he received pancuronium a second time during orotracheal intubation and experienced a recurrence of the rigidity of the jaw muscles. The patient recovered fully without treatment in both instances.…”

“…The occurrence of malignant hyperthermia with the administration of either benzylisoquinolinium or aminosteroidal nondepolarizing neuromuscular blockers is not well established. [10][11][12][13] Therefore, the use of nondepolarizing neuromuscular blockers, particularly aminosteroidal neuromuscular blockers such as rocuronium, is generally considered safe in patients at risk for malignant hyperthermia. [1][2][3]6,14 Here we describe two patients in whom rocuronium was the most likely trigger for the development of malignant hyperthermia.…”