Does ligament laxity occur as a side effect of Sevoflurane?

Question

Hi doctor,

I am a 36 year old female. My height is 5.4 feet and my weight is 105.8 pounds. I was healthy with fine ligaments. Two years back, I had spine surgery for a herniated disk at the level of L5/S1.

Soon after the operation, I got something like sleep myoclonus. The neurologist said that as benign, but I did not have anything like before. I am suffering from loose and weak ligaments in my spine and elsewhere. I also have TMJ dysfunction, sacroiliac joint dysfunction, and ligament laxity.

During anesthesia, I was given one dosage of Midazolam 2 mg, Propofol 200 mg, Cefazolin 2 mg, Atropine 1 mg, Fentanyl 0.3 mg, Rocuronium 40 mg, Neostigmine 2.5 mg, and Sevoflurane 63.05 ml. The operation duration was around two hours and 34 minutes. I do not have any drug allergies. However, I have not received any inhaled anesthetics before. Does ligament laxity occur as a side effect of Sevoflurane? Please advise.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

I have read through your query in detail. Please find my observations below.

Myoclonus or muscle twitching is a known side effect of Sevoflurane use, and it is not a serious concern. Sevoflurane does not cause laxity of ligaments. Very common side effects of Sevoflurane occurring in more than 10 percent of patients are nausea, vomiting, hypotension (low blood pressure), bradycardia (decreased heart rate), cough, and increased agitation.

Common side effects occurring in 1 to 10 percent of patients are increased salivation, tachycardia (increased heart rate), hypertension, laryngospasm (an uncontrolled or involuntary muscular contraction of the vocal folds), airway obstruction, breath holding, apnea (the temporary cessation of breathing), respiratory disorder, somnolence (excessive sleepiness), dizziness, shivering, fever, hypothermia (a significant and potentially dangerous drop in body temperature), headache, increased fluoride in blood, abnormal liver function tests and abnormal blood glucose level.

The uncommon side effects occurring in 0.1 to 1 percent of patients are dry mouth, arrhythmia (irregular heart beat), ECG abnormalities, increased sputum, hypoxia (low levels of oxygen), wheezing, bronchospasm (a sudden constriction of the muscles in the walls of the bronchioles), hyperventilation, pharyngitis, hiccup, hypoventilation (shallow breathing), dyspnea (a feeling of running short of breath), stridor (a high-pitched, whistling sound most often heard while breathing), hypoxia, asthma, crying, nervousness, confusion, insomnia (sleeplessness), confused state, syncope (fainting), hypertonia (increased muscle tone), taste perversion, asthenia (an abnormal weakness), pain, fluorosis (hypo mineralization of tooth enamel), increase in AST (aspartate aminotransferase), increase in ALT (alanine transaminase), bilirubinemia (elevated bilirubin levels), increase in LDH (lactate dehydrogenase), increase in alkaline phosphatase, hypophosphatemia (decreased phosphate levels), acidosis (elevated acid levels), hyperglycemia, increase in BUN (blood urea nitrogen), increase in creatinine, glycosuria (increased glucose in urine), albuminuria (increased protein in urine), amblyopia (decreased eyesight), conjunctivitis (inflammation of the conjunctiva), urination impaired, urine abnormality, urinary retention, oliguria (low urine output), pruritus (itching), and rash.

A rare side effect occurring in less than 0.1 percent of patients is malignant hyperthermia (a rare genetic disorder that triggers a severe reaction to certain anesthesia drugs). Female hormones progesterone (before menstruation) and relaxin (during early pregnancy) cause joint hypermobility and ligament laxity. But, it is difficult to predict whether these factors are causing your symptoms or not. People with connective tissue disorder also might have laxity of joints.

I hope that you get your answer.

Please let me know if you need any help.

Thank you.

Answer 2

Hi,

Welcome back to icliniq.com.

I want to reply with some clarifications to my earlier answer.

It is possible that once the nerve is decompressed with surgery, some pinching of the affected nerve will persist. This is common in low back surgeries and can happen in 20 to 40 percent of patients, and can take two to five years to improve.

Though myoclonus is a rare side effect of Sevoflurane, it is likely that your twitching symptoms are due to the nerves in the lower back, because the twitching due to Sevoflurane will not stay for 2 years after surgery. Patients having side effects due to Sevoflurane get back to normal within two weeks to a maximum of six months.

The TMJ (temporomandibular joint) laxity might be due to your position during surgery and the endotracheal intubation (the placement of a flexible plastic tube into the trachea to maintain an open airway). When getting operated for lower back surgery, the patient is made to lie down on the stomach. During a long surgery, there might be stress on the TMJ. It usually gets better slowly over the years.

There is no problem in brain activity, hypothalamus or pituitary due to anesthesia. It might not be a genetic collagen tissue syndrome but then we have to confirm with test results which are yet to come.

In conclusion, you might have to wait for a few more months to see any improvement of symptoms. If they start worsening, then you can get an MRI scan of the lower back to review post-surgery changes.

It is understandable that the symptoms are not serious, but they are still causing you discomfort. Please be assured that nothing has happened to your brain because of anesthesia, and your symptoms will most likely improve slowly over months or years.

I hope that you get your answer.

Please let me know if you need any help.

Thank you.