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Repeat episodes of severe muscle rigidity in a child receiving sevoflurane

Ira Todd Cohen1, Richard Kaplan

  • 1Department of Anesthesiology, Children's National Medical Center, Washington, DC 20010, USA. icohen@cnmc.org

Paediatric Anaesthesia
|September 16, 2006
PubMed

Insights

Severe muscle rigidity and elevated creatine kinase occurred in a patient during sevoflurane anesthesia. This rare event, not linked to malignant hyperthermia (MH), suggests a potential direct effect of sevoflurane.

Area of Science:

  • Anesthesiology
  • Pharmacology
  • Neuromuscular Disorders

Background:

  • Sevoflurane is a widely used inhalation anesthetic.
  • Malignant hyperthermia (MH) is a rare, life-threatening pharmacogenetic disorder of skeletal muscle.

Observation:

  • A patient experienced two episodes of severe muscle rigidity, increased end-tidal CO2, and elevated creatine phosphokinase.
  • The patient did not exhibit dysrhythmias or hyperthermia.
  • Dantrolene administration was not required.

Findings:

  • Genetic testing for known malignant hyperthermia (MH) mutations was negative.
  • The clinical presentation suggests a possible adverse reaction to sevoflurane.
  • The absence of typical MH signs and negative genetic results warrant further investigation.

Implications:

  • This case highlights a potential, rare adverse effect of sevoflurane not consistent with malignant hyperthermia (MH).
  • Further research is needed to elucidate the mechanism of sevoflurane-induced muscle rigidity.
  • Clinicians should consider sevoflurane as a potential cause for similar episodes in patients without MH susceptibility.

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