A case of convulsion resembling masseter muscle spasm (MMS) during caesarean delivery under subarachnoid block

Abstract

A 28 yrs old female forty weeks gravida was scheduled for caesarean section for less fetal movement. She did not have any bad obstetric history and any complication during previous operation and anaesthetic procedure. Subarachnoid block was performed at L3-L4 interspace with 2.5ml (12.5mg)5% bupivacaine heavy. Suddenly the patient became cyanosed and she tried to tell something but could not talk. Then she was given 100% O2 by face mask but it was not fruitful. Then endotracheal intubation was attempted but failed to achieve due to increased jaw muscle tension and mouth could not be opened like masseter muscle spasm (MMS). At that stage patient became unresponsive and no pulse was palpable, blood pressure was not recordable. Intravenous adrenaline was given immediately and then 100mg of suxamethonium adminstered intravenously. The jaw relaxed within minutes and tracheal intubation was done. General Anaesthesia was maintained with O2/N2O, 0.4% halothane and atracurium. The reversal was good enough and the patient was haemodynamically stable. The patient transferred to the recovery room.

DOI: http://dx.doi.org/10.3329/jbsa.v22i1.18100

Journal of BSA, 2009; 22(1): 35-37