Succinylcholine induced masseter spasm during rapid sequence intubation may require a surgical airway: case report

Abstract

Acute pancreatitis is not an uncommon disease in an emergency department (ED). It manifests as upper abdominal pain, sometimes with radiation of pain to the back and flank region. Isolated left flank pain being the sole manifestation of acute pancreatitis is very rare and not previously identified in the literature. In this report, we present a case of acute pancreatitis presenting solely with left flank pain. Having negative findings on an ultrasound initially, she was misdiagnosed as having possible ''acute pyelonephritis or other renal diseases''. A second radiographic evaluation with computed tomography showed pancreatitis in the tail with abnormal fluid collected extending to the left peri-renal space. We performed a literature review and discussed this rare occurrence of acute pancreatitis. We also discussed the clinical pitfalls in this case.

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

“…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].…”

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

“…Endotracheal intubation can be attempted first but if impossible alternative ways to secure airway like LMA, nasotracheal intubation, or retrograde endotracheal intubation may be utilized per the availability. 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].…”

Guía para la secuencia de inducción e intubación rápida en el servicio de emergencias

“…Puede ser causada por suxametonio, succinilcolina y si este medicamento se va a usar, es necesario investigar, en lo posible, por antecedentes familiares o personales de hipertermia maligna que, de ser positiva, debe considerarse contraindicación. Recuérdese que el uso de suxametonio está asociado con casos de espasmo de maseteros o trismos, que conduce a la subsecuente dificultad para asegurar la vía aérea [78,79] y puede ser una manifestación de una forma leve de hipertermia maligna o estar relacionada con ella.…”