PDF(Pubmed)
Abstract：
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.
METHODS: 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).
CONCLUSIONS: 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.
METHODS: 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).
CONCLUSIONS: 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.
摘要：
背景：麻醉相关的横纹肌溶解症是一种罕见的手术并发症，会导致术后肌痛，弱点,和潜在的肾功能衰竭，如果不及时管理。可能导致这种并发症的诱因包括肌营养不良和肌病。
方法：此罕见病例描述了一名非土著澳大利亚儿科患者出现这种并发症，没有已知的诱发风险因素，也没有明确的病因.一名9岁有哮喘背景的儿童接受了选择性去除胸壁上的瘢痕疙瘩疤痕。程序简短而简单，平稳的麻醉诱导。在出现期间,她出现了气道压力急剧升高，伴有支气管痉挛和喉痉挛，需要使用沙丁胺醇和舒沙胺胺铵，效果良好。在术后初期，患者主诉全身肌痛和肌无力，无法独立动员。暂时恢复正常功能；然而，第二天症状复发并伴有肌痛，需要入院治疗。她被发现患有横纹肌溶解症，经过保守治疗，完全恢复了几周。她被彻底调查了任何根本原因，包括对恶性高热易感性的基因检测（她有一个未知意义的变异，但对导致恶性高热的已知基因异常呈阴性）。
结论：本病例报告证明了将麻醉相关横纹肌溶解症作为急性术后肌无力鉴别的重要性。并概述了一种调查方法。据我们所知,这是儿科文献中描述的首例报告症状双相进展的病例。
方法：此罕见病例描述了一名非土著澳大利亚儿科患者出现这种并发症，没有已知的诱发风险因素，也没有明确的病因.一名9岁有哮喘背景的儿童接受了选择性去除胸壁上的瘢痕疙瘩疤痕。程序简短而简单，平稳的麻醉诱导。在出现期间,她出现了气道压力急剧升高，伴有支气管痉挛和喉痉挛，需要使用沙丁胺醇和舒沙胺胺铵，效果良好。在术后初期，患者主诉全身肌痛和肌无力，无法独立动员。暂时恢复正常功能；然而，第二天症状复发并伴有肌痛，需要入院治疗。她被发现患有横纹肌溶解症，经过保守治疗，完全恢复了几周。她被彻底调查了任何根本原因，包括对恶性高热易感性的基因检测（她有一个未知意义的变异，但对导致恶性高热的已知基因异常呈阴性）。
结论：本病例报告证明了将麻醉相关横纹肌溶解症作为急性术后肌无力鉴别的重要性。并概述了一种调查方法。据我们所知,这是儿科文献中描述的首例报告症状双相进展的病例。
