Sir,
We read with great interest the article - Severe masseter spasms in a Rett syndrome during rapid sequence intubation: A succinylcholine severe side effect.[1] We congratulate the authors for effective management of such complicated case. As in the above case, masseter muscle spasm is commonly seen with succinylcholine and volatile agents.[2] Clinical malignant hyperthermia can be observed in 30% of cases who developed masseter spasm following succinylcholine.[3] However, nondepolarising muscle relaxants e.g., vecuronium, pancuronium have also been implicated in causing masseter spasm.[4] Whenever such catastrophe occurs, we should always be ready with alternate difficult airway management techniques such as fiberoptic nasotracheal intubation, surgical cricothyrotomy, retrograde endotracheal intubation.[5] Effective bag and mask ventilation should be ensured. Laryngeal mask airway has also been reported to be used successfully in the event of succinylcholine-induced masseter spasm where there was small mouth opening but unable to view glottis with a laryngoscope.[6] Avoiding hypoxia by using other options and watching for signs of malignant hyperthermia becomes crucial in the management of such cases.
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References
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