Masseter Spasm Research Articles

Succinylcholine-triggered Masseter Spasm in a Patient with Trigeminal Nerve Palsy

Succinylcholine-triggered Masseter Spasm in a Patient with Trigeminal Nerve Palsy

Halothane-succinycholine-induced masseter spasm: Indicative of malignant hyperthermia susceptibility?: E.H. Flewellen and T.E. Nelson. Anesth Analg 63:693–697, (July), 1984

Halothane-succinycholine-induced masseter spasm: Indicative of malignant hyperthermia susceptibility?: E.H. Flewellen and T.E. Nelson. Anesth Analg 63:693–697, (July), 1984

Masseter Spasm with Anesthesia

Masseter Spasm with Anesthesia

INVESTIGATION OF MALIGNANT HYPERTHERMIA IN DENMARK AND SWEDEN

Units for the investigation of susceptibility to malignant hyperthermia (MH) were set up in Denmark in 1977 and in Sweden in 1981. Two hundred and ten patients from 76 families have been investigated. The diagnosis of MH susceptibility (MHS) was made by in vitro exposure of muscle from vastus medialis to halothane and to caffeine. MHS criteria for the patients in this paper were established from examination of 31 control biopsies, obtained from the same muscle and with the same anaesthesia as the MH patients. The criteria have since been changed to those presented elsewhere in this issue. In our laboratories the halothane test (exposure to 0.5-2% halothane) was the more sensitive: 88% of MHS patients reacted to it. The caffeine test was positive in 68% of MHS patients, 0.5-2.0 mmol litre-1 solutions being the most discriminating. Forty-two percent of MHS patients reacted to only one test. Fulminant MH was the most common reason for investigation; all these families contained MHS members. Masseter spasm occurred as sole sign in 21 families, of which 11 were MHS. Only 10% of MHS patients had other signs or symptoms of neuromuscular disease such as muscle cramps or muscular dystrophy. Three families had experienced sudden infant death syndrome (SIDS), and two teenage brothers in a MHS family died suddenly, but death was unrelated to anaesthesia.

Masseter Spasm Induced by Succinylcholine in Children: Contracture Testing for Malignant Hyperthermia: Report of Six Cases

We evaluated six boys who had developed isolated masseter muscle spasm following intravenous succinylcholine. All were receiving halothane by inhalation.In vitro muscle contracture tests utilizing halothane and caffeine were performed. Four of the six boys had contracture responses similar to those of malignant hyperthermia susceptible patients. Rigidity following succinylcholine should prompt the clinician to consider malignant hyperthermia but has been associated with other myopathic conditions as discussed.

Cricothyrotomy in the Emergency Department

Thirty-eight emergency cricothyrotomies were performed over a 3-year period. This was the first airway control maneuver attempted in 5 patients, 3 of whom had facial and/or neck injury, one apneic with upper airway hemorrhage, and one with aortobronchial fistula. The remaining 33 procedures were performed only after other airway management failed. Five indications were identified among these cases: 1) excessive emesis or hemorrhage (11), 2) possible cervical spine injury with airway compromise (9), 3) technical failure (7), 4) clenched teeth (5), and 5) masseter spasm following succinylcholine administration (1). Fourteen immediate complications occurred in 12 patients (32%). The most frequent was incorrect site of tracheostomy tube placement (5), with 4 of 5 misplaced through the thyrohyoid membrane. Others included execution time greater than 3 minutes (4), unsuccessful tracheostomy tube placement (3), and significant hemorrhage (2). Twelve of the 38 patients were long-term survivors. There was one long-term complication, a longitudinal fracture of the thyroid cartilage during forceful placement of an oversized tube (8 mm inner diameter) through the cricothyroid membrane. This required operative repair and left the patient with severe dysphonia.

Implications of Masseter Spasm after Succinylcholine

Implications of Masseter Spasm after Succinylcholine