Floridis J

Barbour R

2022-10-25

BACKGROUND: 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. CASE PRESENTATION: 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). CONCLUSION: 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.

Gove District Hospital, Nhulunbuy, Northern Territory, Australia. John.Floridis@nt.gov.au.

Royal Darwin Hospital, Darwin, Northern Territory, Australia.

© 2022. The Author(s).

J Med Case Rep. 2022 Oct 25;16(1):387. doi: 10.1186/s13256-022-03629-8.

0000-0003-2251-5147

https://pubmed.ncbi.nlm.nih.gov/36280855/?otool=iaurydwlib

https://hdl.handle.net/10137/12316

16

Female

Child

Humans

Succinylcholine/adverse effects

*Malignant Hyperthermia/complications

Myalgia

Australia

*Rhabdomyolysis/chemically induced/diagnosis

*Anesthetics

Postoperative Period

Albuterol

Postoperative weakness and anesthetic-associated rhabdomyolysis in a pediatric patient: a case report and review of the literature.

Case Reports

Journal Article

Review

Publication