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[Case of muscle rigidity by remifentanil just before the end of surgery]

Satoshi Kashimoto1, Tetsuya Iijma, Miwa Amemiya

  • 1Department of Anesthesia, Fujiyoshida Municipal Hospital, Fujiyoshida 403-0005.

Masui. the Japanese Journal of Anesthesiology
|August 26, 2009
PubMed

Insights

This case report details rare muscle rigidity caused by remifentanil during surgery. Even low doses of this anesthetic can induce rigidity, requiring careful monitoring and intervention.

Area of Science:

  • Anesthesiology
  • Pharmacology

Background:

  • Trigeminal neuralgia is a condition often treated with surgical decompression.
  • Anesthesia for microvascular decompression typically involves agents like propofol, suxamethonium, and remifentanil.

Observation:

  • A 71-year-old male patient developed sudden, severe muscle rigidity and difficult ventilation.
  • This occurred 30 minutes prior to surgery completion, with intratracheal pressure exceeding 40 cmH2O.
  • The patient was under anesthesia with sevoflurane and a low dose of remifentanil (0.05 microg x kg(-1) x min(-1)).

Findings:

  • Remifentanil, even at low doses, can induce significant muscle rigidity.
  • The observed rigidity led to ventilation difficulties during anesthesia.

Implications:

  • Anesthesiologists should be vigilant for muscle rigidity as a potential adverse effect of remifentanil.
  • Prompt administration of muscle relaxants is crucial for managing remifentanil-induced rigidity.
  • This case highlights the importance of considering rare side effects even with standard anesthetic protocols.

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