Dominic Stone
While anesthesia is generally very safe, it can cause side effects during and after a procedure. These side effects can range from minor inconveniences to significant and potentially serious complications. Some common side effects of anesthesia include drowsiness, nausea, vomiting, sore throat, muscle aches, and nerve pain. In rare cases, patients may experience malignant hyperthermia, a serious and potentially deadly reaction to anesthesia that can cause a high fever and muscle contractions. Myoclonic movement after general anesthesia is also uncommon but has been reported in some cases.
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What You'll Learn
Paralytic medications can cause muscle spasms
While anesthesia is generally safe, it can cause side effects during and after a procedure. These side effects are usually minor and temporary, but some more serious side effects can occur. One such rare but serious side effect is myoclonic movement, which can be caused by the use of certain paralytic medications during anesthesia.
Paralytic medications are used as part of general anesthesia to prevent movement during surgery. They work by temporarily interfering with the nerve signals that activate muscles, causing them to completely relax and become unable to move. This is important during surgery to prevent involuntary movements that could cause injury, but it can also lead to muscle spasms or other complications if not carefully managed.
One such complication is masseter spasm, which is associated with the use of the neuromuscular blocking agent succinylcholine. This drug can cause a marked increase in tension in the masseter muscle, preventing the mouth from opening. In addition, succinylcholine has been linked to other serious side effects in children, including cardiac arrest, hyperkalemia, and rhabdomyolysis, especially in those with undiagnosed Duchenne's muscular dystrophy. As a result, the FDA has issued a warning against its elective use in children.
Another potential complication of paralytic medications is malignant hyperthermia, a rare but serious reaction to anesthesia that can cause a rapid fever and muscle contractions. This condition can be life-threatening, so it is important to inform your anesthesiologist if you or any family members have experienced heat stroke or malignant hyperthermia in the past.
While these complications are rare, it is important to be aware of them and to involve an anesthesiologist in your care before and during surgery. Anesthesiologists are medical doctors who specialize in anesthesia, pain management, and critical care, and they can help lower your risk of experiencing side effects by taking into account your medical history, health habits, and lifestyle.
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Malignant hyperthermia
The risk of malignant hyperthermia is higher if you or a close relative has a history of an event suspected to be malignant hyperthermia during anesthesia, or a history of muscle tissue breakdown called rhabdomyolysis. In rare cases, people at risk of malignant hyperthermia may show signs of a reaction after intense physical activity during excessive heat or humidity, during a viral illness, or when taking statin medication.
The principal diagnostic features of MH include an unexplained elevation of end-tidal carbon dioxide (ETCO2) concentration, muscle rigidity, tachycardia, acidosis, hyperthermia, and hyperkalemia. The "gold standard" for diagnosis is the in vitro contracture test (IVCT), which is based on contracture of muscle fibres in the presence of halothane or caffeine.
Genetic testing can reveal whether an individual has malignant hyperthermia susceptibility (MHS), the genetic disorder that increases the risk of malignant hyperthermia when exposed to certain anesthesia drugs. The affected gene is most commonly inherited from one parent who also has it. The most commonly affected gene is RYR1, which is a mutation of the ryanodine receptor (type 1) located on the sarcoplasmic reticulum (SR) within skeletal muscle cells.
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Muscle soreness
It is important to note that most side effects of anaesthesia are minor and temporary. However, there are some rare but serious complications that can occur. Malignant hyperthermia, for example, is a rare but potentially deadly reaction to anaesthesia that can cause a rapid fever and muscle contractions. This condition should be discussed with an anesthesiologist before surgery if there is any family history of it.
To prevent and manage muscle soreness after surgery, it is important to follow the advice of medical professionals. Doctors recommend appropriate movement within reason to aid recovery, as it can help prevent clots and speed up healing. Medications can also be prescribed to manage muscle soreness and other side effects, depending on their severity.
In addition to muscle soreness, other common side effects of anaesthesia include a sore throat, nausea, constipation, changes in appetite and sleep patterns, and feelings of depression. It is normal to feel drowsy after anaesthesia, and it is important to have a trusted driver to take you home after surgery.
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Nerve damage
Although rare, nerve damage is a recognised complication of general anaesthesia. It can cause temporary or permanent neuropathic pain, numbness, or weakness. The incidence of nerve damage varies depending on the type of surgery, the patient's age, and other risk factors.
Peripheral nerve injury (PNI) is a common type of nerve damage caused by anaesthesia. It can result from errors in patient positioning, injection needles used in regional anaesthesia, or the neurotoxicity of adjuvants used in perineural anaesthesia. Studies suggest that the incidence of PNI in a general population of surgical patients is less than 1%, with higher rates in cardiac, neurosurgery, and some orthopedic procedures.
In some cases, nerve damage may be caused by factors other than direct surgical or anaesthesia-related causes, such as postsurgical inflammatory neuropathy. This condition is believed to be an immune-mediated response to physiological stress, such as surgery or regional block, and is treated with prolonged high-dose corticosteroids.
To prevent nerve damage during anaesthesia, it is essential to involve an anaesthesiologist in your care. They will review your medical history, health habits, and lifestyle to assess your risk of nerve damage and take steps to lower that risk. New advances in monitoring can also aid anaesthesiologists in the early detection of PNI, allowing for prompt intervention.
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Myoclonic movement
Myoclonus is a brief, involuntary, irregular (lacking rhythm) twitching of a muscle, a joint, or a group of muscles. Myoclonus is not a diagnosis of a disease but a medical sign. Myoclonic jerks are usually caused by sudden muscle contractions (positive myoclonus) or brief lapses of contraction (negative myoclonus). Myoclonus can be categorised based on where the movement starts in the nervous system.
Types of Myoclonus
- Cortical myoclonus starts in the cerebral cortex (the outer layer of the brain). In this type, myoclonic jerks usually involve only a few muscles in one part of the body, usually in the limbs, but jerks involving many muscles may also occur. It becomes more intense when a person tries to move in a certain way (action myoclonus) or in response to sensory stimulation (stimulus-sensitive myoclonus).
- Reticular reflex myoclonus starts in the brainstem (the part of the brain that controls vital functions such as breathing). Myoclonic jerks usually affect the whole body, mimicking a startle reflex. It can also be triggered by a person's movement or surroundings.
- Spinal myoclonus begins in the spinal cord and can involve muscle groups controlled by one or more connected parts of the spinal cord, called segmental myoclonus.
- Stimulus-sensitive myoclonus is triggered by various external events, including noise, movement, light, or being surprised.
- Sleep myoclonus (also known as hypnic myoclonus) happens during sleep and sleep transitions, often as a person is drifting off to sleep.
- Essential myoclonus occurs on its own and is not caused by abnormalities in the brain or nerves. It is usually stable and doesn't get worse over time, or progresses very slowly.
- Action myoclonus is triggered or intensified by voluntary movement or even the intention to move. It may be made worse by attempts at precise, coordinated movements.
- Epileptic myoclonus occurs within an epilepsy syndrome. Some examples include Juvenile myoclonic epilepsy (JME), which starts around puberty and involves myoclonic seizures, usually of the neck, shoulders, or upper arms. Progressive myoclonus epilepsy (PME) is a rare and fatal disorder that gets worse over time.
- Benign neonatal sleep myoclonus (BNSM) affects newborn babies. Newborns with this condition will have sudden, jerky movements of their limbs or bodies in their sleep. This condition is harmless and about 95% of cases go away by 6 months of age.
- Palatal myoclonus involves a regular, rhythmic contraction of one or both sides of the rear of the roof of the mouth (soft palate). The condition usually appears in adults and sometimes does not go away.
- Opsoclonus myoclonus (OMS) or Dancing Eyes-Dancing Feet Syndrome is a rare disorder that affects the eyes and muscles and causes other problems. In young children, it is most often caused by a tumour called neuroblastoma that triggers the immune system to attack the nervous system by mistake.
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Frequently asked questions
Yes, muscle spasms can be caused by general anesthesia. Myoclonic movement after general anesthesia is rare but has been recorded in some case reports.
The exact cause of muscle spasms after general anesthesia is unknown. However, drugs such as propofol, fentanyl, ramonsetron, and nefopam are suspected to be the cause of postoperative myoclonic movement.
The most common side effects of general anesthesia are nausea, vomiting, sore throat, muscle aches, nerve pain, itching, drowsiness, and chills.
Anesthesiologists are aware of the potential for muscle spasms after general anesthesia and will try to use alternative muscle relaxants when possible. Additionally, they will monitor you for signs of problems and treat them if they occur after your procedure.
