Expert: Ronald Levy, M.D. - 7/24/2010

Question
Dr. Levy,
I recently had a laproscopic procedure under general anest.  The day of the surgery I was fine.  The next morning I woke to every muscle, especially my calves, thighs, buttocks & neck being stiff. I could barely move until I was able to loosen up. I could feel every muscle, even the top of my feet and hands.  Hours after being up and moving it was still in my feet as well as everywhere else so I knew it wasn't trapped gas from procedure.  If I sat even for a minute I would lock up tight again. It was as if my muscles were contracted.  Consulted w/gyno, took benadryl rest of that day. 2 days post-op still no improvement, gyno had me go in to see anestesiologist and was told it was an uncommon reaction to the paralytic and should start to improve and pass in 48-72 hours.  It did improve slowly with only my calves bothering me on day 4.  Day 5 I woke up fine, abs may have been tight but that could have been from procedure I guess.  I've had prior surgeries w/no complications.  I've since seen gyno for follow up and he is fascinated having only seen this twice in 14 years.  He is going to find out which agents were used thinking maybe I can avoid this in the future.  I have quite a few unanswered questions and would appreciate any knowledge you can share with me. Are there newer more preferred agents that may not have been used in my prior surgeries?  Could I have developed an allergy to an agent that I may have been fine w/in the past?  What is the name for this reaction?  How common is it?
Did it do any lasting damage?  Are there any lingering effects I should be concerned about or watchful for? I'm sure I could come up with more questions.  Any information you can share is greatly appreciated.  Thank you.  Kathy

Answer
You probably had this reaction to succinylcholine and it is not that uncommon (maybe to the extent you had it is unusual but many patients have total body aches). This is not an allergic reaction. They often use succinylcholine when they do a rapid sequence induction. There is no name for the reaction, there are no lasting effects and there is nothing to be concerned about in the future.

Ronald Levy, MD
Professor of Anesthesiology
UTMB-Galveston