Accidental Trismus Leading to Failed Endotracheal Intubation and Abandoned Surgery Following Rapid Sequential Induction of General Anesthesia: A Case Report

Abstract

A 64-year-old female patient, weighing 46 kg, 156 cm tall, and BMI of 18.9 kg/m², was scheduled to have the left tibial intramedullary needle under general anesthesia. General anesthesia induction was performed sequentially using sufentanyl 15 μg, propofol 120 mg, and cis-atracurium 10 mg intravenously. 2.5 minutes after good mask administration of oxygen by artificial ventilation, the anesthesiologist planned to intubate the trachea and found that her mandible and jaw joint were fixed, the masseter muscle was stiff, and the mouth could not open. Propofol 50 mg was added to deepen the anesthesia, which remained so. The surgery was cancelled. After waking up from anesthesia, the patient recovered her spontaneous mouth opening activity with a maximum mouth opening of 3.3 cm. During this period, the patient's nasopharyngeal body temperature monitoring was unchanged. In recent years, there have been a few cases of masseter muscle spasm (MMS) induced by general anesthesia, and the mechanism of which is still unclear. This sudden MMS after general anesthesia induction led to the anesthesiologist’s mental tension and failure of endotracheal intubation. In such an emergency, if the anesthesiologist's skills and associated equipment are inadequate, the patient should be decisively awakened from anesthesia and the abandoned operation.