Advertisement

Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Masseter spasm induced by succinylcholine in children: Contracture testing for malignant hyperthermia: Report of six cases

Abstract

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.

RéSUMé

Six jeunes garçons qui avaient présenté un spasme n’impliquant que le masséter à la suite d’une injection de succinylcholine par la voie veineuse ont été étudiés. Tous ces malades recevaient de l’halothane. Des tests de contracture à l’halothane et à la caféine in vitro ont été effectués et ont démontré dans quatre cas sur six des contractures identiques à celles qu’on rencontre chez le sujet susceptible à l’hyperthermie maligne. La rigidité qui suit l’injection de succinylcholine devrait toujours faire suspecter l’hyperthermie maligne mais ne peut éliminer d’emblée d’autres myopathies.

References

  1. 1.

    Britt, B.A. &Kalow, W. Malignant hyperthermia: A statistical review. Can. Anaesth. Soc. J.17: 293–315 (1970).

  2. 2.

    Barlow, M. &Isaacs, H. Malignant hyperthermia deaths in a family. Brit. J. Anaesth.42: 1072–1076 (1970).

  3. 3.

    Donlon, J.V., Newfield, P., Streter, F. &Ryan, J.F. Implications of masseter spasm after succinylcholine. Anesthesiology49: 298–301 (1978).

  4. 4.

    Zinganell, K., Sajons, M. &Hammami, G. Mild form of malignant hyperthermia? Or, Abnormal reaction to succinylcholine? Prakt. Anasth.10: 222–227 (1975).

  5. 5.

    Satnick, J.H. Hyperthermia under anesthesia with regional muscle flaccidity. Anesthesiology30: 472–474 (1969).

  6. 6.

    Ryan, J.F. Malignant hyperthermia: Recognition. In 29th Annual Refresher Course Lectures, American Society of Anesthesiologists, Lecture #119B, 1978.

  7. 7.

    Sonnenklar, N. &Krasna, I.H. Clinical management of malignant hyperpyrexia. J. Pediatric Surg.11: 617–623 (1977).

  8. 8.

    Moore, W., Watson, R. &Summary, J. Massive myoglobinuria precipitated by halothane and succinylcholine in a member of a family with elevation of serum creatine phosphokinase. Anesth. Analg. (Cleve.)55: 680–682 (1976).

  9. 9.

    Schaer, H., Steinmann, B., Jerusalem, S.,et. al. Rhabdomyolysis induced by anaesthesia with intra-operative cardiac arrest. Brit. J. Anaesth.49: 495–499 (1977).

  10. 10.

    Auerback, V.H., DiGeorge, A.M. Mayer, B.W., Hayden, M.,et al. Rhabdomyolysis and hyperpyrexia in children after administration of succinylcholine.In: Gordon, R.A., Britt, B.A. & Kalow, W. International Symposium on Malignant Hyperthermia. Springfield: Chas, Thomas, 1973; 30–51.

  11. 11.

    Bernhardt, D. &Hoerder, M.H. Anesthesia induced myoglobinuria without hyperpyrexia - An abortive form of malignant hyperthermia?In: Aldrete, J.A., Britt, B.A., eds. Second International Symposium on Malignant Hyperthermia. New York: Grune and Straton, 1978: 419–425.

  12. 12.

    Barnes, P.K. Masseter spasm following intra venous suxamethonium. Br. J. Anaesth.45: 759–760 (1973).

  13. 13.

    Rosenberg, H., Reed, S. &Heiman, T. Masseter spasm, rhabdomyolysis and malignant hyperthermia. Anesthesiology53: S248 (1980).

  14. 14.

    Britt, B.A., Preanesthetic Diagnosis of Malig- nant Hyperthermia.In: Britt, B.A. ed. International Anesthesiology Clinics - Malignant Hyperthermia. Boston: Little, Brown and Company, 17(4): 63–96 (1979).

  15. 15.

    Nelson, T.E. &Flewellen, E.H. Malignant hyperthermia: Diagnosis, treatment, and investigations of a skeletal muscle lesion. Tex. Rpts. Bio. Med.38: 105–120 (1979).

  16. 16.

    Moulds, R.F.W. &Denborough, M.A. Myopathies and malignant hyperpyrexia. Brit. Med. J.3: 530 (1974).

  17. 17.

    Body, J.R. Muscle rigidity following adminis- tration of succinylcholine. Anesthesiology29: 159–162 (1968).

  18. 18.

    Relton, J.E.S., Creighton, R.E., Conn, A.W. &Nabeta, S. Generalized muscular hypertonicity associated with general anaesthesia: A suggested anaesthetic managment. Can. Anaesth. Soc. J.14: 22–25 (1967).

  19. 19.

    Kalow, W., Britt, B.A., Terreau, M.E. &Haist, E. Metabolic error of muscle metabolism after recovery from malignant hyperthermia. Lancet2: 895–898 (1970).

  20. 20.

    Brim, V.D. Denervation supersensitivity: The response to depolarizing agents. Brit. J. Anaesth.45: 222–226 (1973).

  21. 21.

    Orndahl, G. Myotonie human musculature: Stimulation with depolarizing agents. Acta Med. Scand.772: 753–765 (1962).

  22. 22.

    Patterson, I.S. Generalized myotonia follow- ing suxamethonium. Brit. J. Anaesth.34: 340–341 (1962).

  23. 23.

    Thiel, R.E. The myotonic response to suxamethonium. Brit. J. Anesth.39: 815–820 (1967).

  24. 24.

    Baraka, A., Haddad, C, Afifi, A. &Baroody, M. Control of succinylcholine induced myotonia by d-tubocurarine. Anesthesiology33: 669–670 (1970).

  25. 25.

    Saidman, L.J., Havard, E.S. &Egeh, E.I. Hyperthermia during anesthesia. J.A.M.A.190: 1029–1032 (1964).

  26. 26.

    Morley, J.B., Lambert, T.F. &Kukulas, B.A. A case of hyperpyrexia with myotonia congenita.In: Kukulas, B. A., ed. Proceedings of the Second International Congress on Muscle Diseases. Amsterdam: Exerpta Medica, 543–546, 1973.

  27. 27.

    King, J.O., Denborough, M.A. &Zapf, P.W. Inheritance of malignant hyperpyrexia. Lancet1: 365–370 (1972).

  28. 28.

    Davies, D.D. Hypertonie syndrome associated with suxamethonium administration. Brit. J. Anaes.42: 656 (1970).

  29. 29.

    McLaren, C.A.B. Myoglobinuria following the use of suxamethonium chloride. Brit. J. Anaesth.40: 901–902 (1968).

  30. 30.

    Jensen, K., Bennike, K.A., Hansel, H.K. &Olesen, H. Myoglobinuria following anaesthesia including suxamethonium. Brit. J. Anaesth.40: 329–334 (1968).

  31. 31.

    Bennike, KA. &Jarnum, S. Myoglobinuria with acute renal failure possible induced by suxamethonium. Brit. J. Anaesth.36: 730–736 (1964).

  32. 32.

    Miller, E.D., Sanders, D.B., Rowlingson, J.C., Berry, F.A.,et al. Anesthesia-induced rhabdomyolysis in a patient with Duchenne’s muscular dystrophy. Anesthesiology48: 146–148 (1978).

  33. 33.

    Bloom, D.A., Fonkalsrud, E. W. &Reynolds, R.C. Malignant hyperpyrexia during anesthesia in childhood. J. Pedi. Surg.11: 185–190 (1976).

Download references

Author information

Correspondence to Eugene H. Flewellen or Thomas E. Nelson.

Additional information

Supported in part by NIH Grant DHEW 5R01 GM 23875(4) and by a Grant (RR-73) from the General Clinical Research Centers Program of the Division of Research Resources, National Institutes of Health.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Flewellen, E.H., Nelson, T.E. Masseter spasm induced by succinylcholine in children: Contracture testing for malignant hyperthermia: Report of six cases. Canad. Anaesth. Soc. J. 29, 42–49 (1982). https://doi.org/10.1007/BF03007947

Download citation

Key Words

  • Malignant hyperthermia
  • Succinylcholine
  • Masseter spasm