pancuronium and Temporomandibular-Joint-Disorders

Temporomandibular joint (TMJ) dislocation during anaesthesia is a rare occurrence. Patients with a history of prior dislocations or TMJ dysfunction, and patients with mandibular retrognathism are at risk of this complication. This is a case report of delayed diagnosis of TMJ dislocation after a general anaesthesia for aortic valvular replacement surgery in a predisposed patient. Considering this unusual presentation, TMJ evaluation should be performed during preoperative anaesthetic assessment. In at-risk patients, one should not worry about TMJ dislocation during intubation but concentrate on glottic exposure. However, afterwards, one should be highly aware of this possible complication in order to detect it early, allowing an immediate simple manual reduction. This manoeuver may be performed with or without sedation by a practitioner, familiar with this way of resetting a dislocated jaw.

Topics: Anesthesia, Inhalation; Aortic Valve; Disease Susceptibility; Emergencies; Heart Valve Prosthesis Implantation; Humans; Intraoperative Complications; Intubation, Intratracheal; Joint Dislocations; Laryngoscopy; Male; Malocclusion, Angle Class II; Middle Aged; Musculoskeletal Manipulations; Neuromuscular Nondepolarizing Agents; Pancuronium; Premedication; Stress, Mechanical; Temporomandibular Joint Disorders; Temporomandibular Joint Dysfunction Syndrome; Time Factors

Fibreoptic bronchoscopic guided tracheal intubation is often the first choice for clinicians familiar with the technique, when faced with a patient in whom tracheal intubation presents known or possible difficulties. Regardless of the technique chosen, anticipated and unanticipated problems may arise. We report three patients with known difficult airways that illustrate the utility of light wand guided oral and nasotracheal intubation when tracheal intubation with fibreoptic bronchoscopy proved impossible.

Topics: Adolescent; Anesthetics, Inhalation; Anesthetics, Intravenous; Ankylosis; Bronchoscopy; Child; Child, Preschool; Ear, External; Equipment Design; Facial Asymmetry; Female; Fiber Optic Technology; Halothane; Humans; Intubation, Intratracheal; Light; Male; Neuromuscular Nondepolarizing Agents; Pancuronium; Temporomandibular Joint Disorders; Thiopental; Vecuronium Bromide