Gove District Hospital, Nhulunbuy, Northern Territory, Australia.
Royal Darwin Hospital, Darwin, Northern Territory, Australia.
J Med Case Rep. 2022 Oct 25;16(1):387. doi: 10.1186/s13256-022-03629-8.
Anesthesia-associated rhabdomyolysis is a rare complication of surgery that causes postoperative myalgia, weakness, and potential renal failure if not managed promptly. Predisposing conditions that may lead to this complication include muscular dystrophies and myopathies.
This rare case describes a pediatric non-Indigenous Australian patient developing this complication, with no known predisposing risk factors, and no clear etiology. A 9-year-old child with a background of asthma underwent an elective removal of keloid scar on her chest wall. The procedure was brief and uncomplicated, with an uneventful induction of anesthesia. During the emergence period, she developed acutely raised airway pressures with bronchospasm and laryngospasm requiring the use of salbutamol and suxamethonium with good effect. In the initial postoperative period, the patient complained of generalized myalgia and muscle weakness and was unable to mobilize independently. There was transient recovery to normal function; however, a recurrence of symptoms the following day with associated myalgias warranted admission to hospital. She was found to have rhabdomyolysis that was managed conservatively with a full recovery of several weeks. She was thoroughly investigated for any underlying cause, including genetic testing for malignant hyperthermia susceptibility (she had a variant of unknown significance but was negative for the known genetic abnormalities that cause malignant hyperthermia).
This case report demonstrates the importance of considering anesthesia-associated rhabdomyolysis as a differential for acute postoperative weakness, and outlines an investigative approach. To the best of our knowledge, it is the first case described in the pediatric literature to report biphasic progression of symptoms.
麻醉相关横纹肌溶解症是一种罕见的手术并发症，若不及时处理，可导致术后肌痛、无力，并可能导致肾衰竭。可能导致这种并发症的易患条件包括肌肉营养不良和肌病。
本罕见病例描述了一名非土著澳大利亚儿科患者发生这种并发症的情况，她没有已知的易患风险因素，也没有明确的病因。一名 9 岁儿童有哮喘病史，行择期性切除胸壁瘢痕疙瘩。手术过程短暂且无并发症，麻醉诱导无异常。在苏醒期间，她出现气道压急剧升高，伴有支气管痉挛和喉痉挛，需要使用沙丁胺醇和琥珀胆碱，效果良好。在术后初期，患者出现全身肌肉疼痛和肌无力，无法独立移动。她的功能有短暂恢复正常；然而，第二天症状再次出现，伴有肌肉疼痛，需要住院治疗。她被诊断为横纹肌溶解症，经保守治疗数周后完全康复。她接受了彻底的检查，以寻找任何潜在的病因，包括恶性高热易感性的基因检测（她有一个意义不明的变异体，但对导致恶性高热的已知遗传异常呈阴性）。
本病例报告表明，在急性术后肌无力时，应考虑麻醉相关横纹肌溶解症作为鉴别诊断，并概述了一种检查方法。据我们所知，这是儿科文献中首次描述症状呈双相进展的病例。
