Severe Bradycardia Occurring after Assisted Mouth Opening : A Case Report

HAYAKAWA Yoshio, FUJII-ABE Keiko, NAKANO Takuya, SUZUKI Masayuki, KAWAHARA Hiroshi

doi:10.24569/jjdsa.48.3_111

<p> This report describes a case of severe bradycardia caused by assisted mouth opening under general anesthesia. The patient was a 46-year-old woman scheduled for scar revision under general anesthesia because of tendon hyperplasia and aponeurisis of the masticatory muscles. She had previously undergone surgery for masticatory muscle tendon-aponeurosis hyperplasia when she was 28 years old. An electrocardiogram performed during the preoperative examinations was within normal limits. The patient's intraoperative blood pressure and heart rate were stable until after the completion of the bilateral scar revision, at which time the surgeon opened the patient's mouth to evaluate the amount of opening. The patient's blood pressure immediately increased and she developed sinus bradycardia, with her heart rate dropping to 27 times/min. Immediately after closure of the mouth, the electrocardiogram showed a decrease in the of QRS wave. Atropine sulphate (0.5 mg) was administered after preparation for transcutaneous pacing. The heart rate recovered to 80 beats/min, and her sinus rhythm and circulation stabilized, enabling the operation to continue. No further complications occurred during the emergency or throughout the postoperative period. In the present case, the parasympathetic nervous system was tense after remifentanil administration, and a vagal reflex was easily induced. In addition, stimulation from the sinus nodules was thought to have been weakened by the parasympathetic nervous system, which was triggered by the opening load ; an atrial ectopic pacemaker stimulated the sinus nodules, but a QRS wave did not appear.</p>

Severe Bradycardia Occurring after Assisted Mouth Opening : A Case Report

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