Department of Anaesthesia, The Ipswich Hospital, Suffolk, UK.
Br J Anaesth. 2010 Apr;104(4):487-9. doi: 10.1093/bja/aeq035. Epub 2010 Feb 26.
A previously fit 12-yr-old boy, who had no previous history of anaesthesia, underwent general anaesthesia using isoflurane for an elective circumcision. After uneventful surgery and anaesthesia, he suffered a cardiorespiratory arrest in the recovery room. Prompt oxygenation and cardiopulmonary resuscitation (CPR) were instituted. The initial serum potassium was >13 mmol litre(-1) and prolonged CPR was required while potassium levels were reduced. Further investigation demonstrated a creatine kinase (CK) >70 000 U litre(-1) which was consistent with a diagnosis of rhabdomyolysis. Despite requiring CPR for 1 h 45 min and a prolonged intensive care admission for multi-organ failure, the child has made an excellent recovery, including normal cognitive function. Subsequent genetic analysis has shown that the boy has previously undiagnosed Becker's muscular dystrophy. We believe that the patient had acute rhabdomyolysis as a result of a volatile anaesthetic agent in association with an undiagnosed muscular dystrophy. In recent years, largely based on case report literature, there has been a shift in opinion as to the cause of such adverse perioperative events. What was previously thought to be malignant hyperpyrexia (MH) is now considered to be anaesthesia-induced rhabdomyolysis, an alternative and distinct reaction. The distinguishing feature of anaesthesia-induced rhabdomyolysis from MH is an acute rhabdomyolysis, without preceding hypermetabolism.
一位之前身体健康的 12 岁男孩，此前没有麻醉史，在全身麻醉下接受了择期包皮环切术。手术和麻醉过程顺利，但在恢复室中发生了心肺骤停。及时进行了氧合和心肺复苏（CPR）。初始血清钾>13mmol/L，在降低血钾的同时需要长时间进行 CPR。进一步的检查显示肌酸激酶（CK）>70000U/L，符合横纹肌溶解症的诊断。尽管需要进行 1 小时 45 分钟的 CPR，并因多器官衰竭而长时间入住重症监护病房，但患儿恢复良好，包括认知功能正常。随后的基因分析显示，该男孩患有先前未诊断的贝克型肌营养不良症。我们认为患者由于挥发性麻醉剂与未诊断的肌肉疾病的共同作用而发生急性横纹肌溶解症。近年来，主要基于病例报告文献，对于此类围手术期不良事件的病因的观点发生了转变。以前被认为是恶性高热（MH）的现在被认为是麻醉诱导的横纹肌溶解症，这是一种替代且不同的反应。麻醉诱导的横纹肌溶解症与 MH 的区别特征是急性横纹肌溶解症，无先前的代谢亢进。
