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[Sevoflurane can induce rhabdomyolysis in Duchenne's muscular dystrophy]
Hidenori Takahashi1, Mitsuru Shimokawa, Keiichi Sha
1Department of Anesthesiology, Nara Medical University, Kashihara 634-8522.
Abstract:
Rhabdomyolysis is one of the perioperative complications in patients with Duchenne's muscular dystrophy (DMD). It has been suggested that sevoflurane can be used safely for anesthesia in patients with DMD. In this report, we describe a case with DMD who received anesthesia with sevoflurane, in which rhabdomyolysis developed postoperatively. A 6-year-old boy diagnosed as DMD was scheduled for tonsillectomy under general anesthesia. Preoperative laboratory examination revealed a high level of creatine kinase (CK) (16,000-32,000 IU.l-1). An abnormality of the dystrophin gene was detected by DNA analysis. Anesthesia was induced with sevoflurane without muscle relaxant, and maintained with sevoflurane in nitrous oxide and oxygen under controlled ventilation. The course of anesthesia was uneventful and the patient recovered smoothly. Three hours postoperatively, dark red urine with a high concentration of myoglobin (1,390,000 ng.ml-1) was recognized with a high level of CK (63,500 IU.l-1). Body temperature was 37.6 degrees C, and electrocardiogram and serum potassium were within normal ranges. After the diuresis with mannitol and furosemide, the urine became clear. On the 4th postoperative day, he was discharged without any complication. This case suggested that rhabdomyolysis can develop after sevoflurane anesthesia in patients with DMD.
Insights
Rhabdomyolysis, a complication of Duchenne muscular dystrophy (DMD), can occur even after sevoflurane anesthesia. This case highlights the risk despite previous suggestions of sevoflurane safety in DMD patients.
Area of Science:
- Anesthesiology
- Neuromuscular Disorders
- Pediatric Surgery
Background:
- Duchenne muscular dystrophy (DMD) patients face perioperative risks, including rhabdomyolysis.
- Sevoflurane has been considered a potentially safe anesthetic agent for DMD patients.
Observation:
- A 6-year-old boy with DMD underwent tonsillectomy under sevoflurane anesthesia.
- He exhibited elevated creatine kinase (CK) preoperatively and a dystrophin gene abnormality.
- Postoperatively, the patient developed rhabdomyolysis with dark urine and significantly increased CK and myoglobin levels.
Findings:
- Despite an uneventful anesthetic course with sevoflurane, the DMD patient experienced severe rhabdomyolysis.
- Prompt diuresis treatment led to urine clearing and patient recovery.
- This case challenges the assumption of sevoflurane's universal safety in DMD anesthesia.
Implications:
- Anesthetic management for DMD patients requires careful consideration of potential complications like rhabdomyolysis.
- Further research is needed to clarify the safety profile of sevoflurane in the context of DMD.
- Clinicians should remain vigilant for rhabdomyolysis signs in DMD patients post-sevoflurane anesthesia.