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Cardiac arrest on the day following surgery in children with unrecognized rhabdomyolysis
L O Warner1, C B Reiner, T P Beach
1Department of Anesthesiology, Columbus Children's Hospital, OH, USA.
Insights
Two children suffered cardiac arrest from rhabdomyolysis after anesthesia. This highlights rare, heritable metabolic myopathies as a cause, distinct from malignant hyperthermia, requiring careful perianesthetic management.
Area of Science:
- Pediatric Anesthesiology
- Neuromuscular Disorders
- Metabolic Myopathies
Background:
- General anesthesia for adenotonsillectomy can unmask underlying conditions.
- Malignant hyperthermia and muscular dystrophies are common considerations for perioperative rhabdomyolysis.
- This study explores less frequent causes of anesthesia-associated rhabdomyolysis in children.
Observation:
- Two male pediatric patients developed cardiac arrest post-anesthesia.
- Rhabdomyolysis was identified as the cause, but typical triggers like malignant hyperthermia were absent.
- Patients had undergone uneventful adenotonsillectomy under general anesthesia.
Findings:
- Heritable metabolic myopathies (enzymopathies) can cause severe rhabdomyolysis following anesthesia.
- These conditions are infrequently associated with anesthesia but pose life-threatening risks.
- Identifying and avoiding specific perianesthetic triggers is crucial for these patients.
Implications:
- Anesthesiologists and postanesthetic caregivers must recognize signs of rare metabolic myopathies.
- Proactive diagnostic evaluation and trigger avoidance can prevent catastrophic outcomes.
- This research emphasizes the need for broader differential diagnoses in pediatric perioperative complications.
Abstract:
We present tow male children who experienced cardiac arrest secondary to unrecognized rhabdomyolysis on the day following an uneventful general anesthetic and recovery room course for adenotonsillectomy. Neither child exhibited hypermetabolism typical of malignant hyperthermia or appeared to have a dystrophinophy, prompting the authors to search for other etiologies of childhood rhabdomyolysis infrequently associated with anesthesia. In this report, we review the heritable metabolic myopathies caused by enzyme deficiencies (enzymopathies) that can lead to life-threatening rhabdomyolysis following certain triggering conditions, and we offer suggestions for avoiding these triggers in the perianesthetic period. We also describe key symptoms an signs that postanesthetic caregivers should be aware of, and briefly comment on follow-up diagnostic studies.