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Droperidol-Treated PONV and Bilateral Mandibular Fracture After Maxillofacial Surgery

Freymond, Daniel, MD, PhD; Mustaki, Jean-Pierre, MD; Spahn, Donat R., MD; Jaques, Bertrand, MD, DMD

doi: 10.1097/00000539-200211000-00082
LETTERS TO THE EDITOR: Letters & Announcements

Department of Anesthesiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland

Department of Ear, Nose and Throat Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland

To the Editor:

A healthy 20-year-old patient underwent a bimaxillary osteotomy to correct a facial dysmorphosis. The patient’s teeth were not fixed in the closed position at the end of the operation. General anesthesia included nasotracheal intubation during propofol, vecuronium, fentanyl and remifentanil anesthetic. IV clonidine 150 μg was added to maintain a 70–80 mmHg mean arterial blood pressure, and methylprednisolone 125 mg was added to reduce swelling. No gastric tube was placed. Postoperative pain was treated with acetaminophen, mefenamate and morphine. Eight and 33 hours postoperatively, two vomiting episodes of swallowed blood were treated by two isolated IV boluses of 0.625 mg (8.4 μg/kg) droperidol. The second droperidol injection was accompanied by an acute state of anxiety, generalized muscle contracture, and the appearance of a new mandibular pain. Clinical and radiological examination revealed a fracture of both mandibular angles.

These fractures may have resulted from either the vigorous opening of the jaw produced by vomiting or the acute state of droperidol-induced restlessness, or both. The latter, a spasm of the pterygo-masseter sleeve, may have resulted in a fracture of the internal valves of the sagittal split mandibular osteotomy. Such side effects are rare (1), but may have serious con- sequences.

Daniel Freymond, MD, PhD

Jean-Pierre Mustaki, MD

Donat R. Spahn, MD

Bertrand Jaques, MD, DMD

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1. Henzi I, Sonderegger J, Tramèr MR. Efficacy, dose-response, and adverse effects of droperidol for prevention of postoperative nausea and vomiting. Can J Anesth 2000; 47: 537–51.
© 2002 International Anesthesia Research Society