DOI: 10.36347/sjmcr.2016.v04i10.004

Pages: 712-715

A 58-year-old man without any significant medical history was scheduled for closed reduction of a subcondylar mandibular fracture after trauma. The fracture was treated under general anesthesia by closed reduction with intermaxillary fixation with rubber bands. The surgical procedure was completed in 45 minutes, and the surgeon confirmed the complete reduction of the subcondyle by the portable radiography scanning. Three minutes after sugammadex was administered for reversal of the neuromuscular blockade, the patient became agitated and began moving and attempting opening his mouth while still intubated. The patient’s agitation during the recovery period was suspected to have resulted in failure of the closed reduction. Repeat radiography confirmed that the previous reduction had failed, indicating that the fracture now required open fixation. The patient was returned to the operating room, where he underwent successful open reduction and fixation. Neuromuscular blockade can lead to inaccurate assessment of anesthetic depth. Inadequate depth of anesthesia, as revealed by administration of sugammadex to reverse the neuromuscular blockade, can lead to patient agitation, thus increasing the likelihood of indication for re-operation to repair a previous closed fracture reduction. Therefore, unless depth of anesthesia is monitored concurrently, administration of sugammadex poses a potential risk factor for unmasking inadequate anesthetic depth.