TYK129

Following an uneventful anesthetic with sevoflurane and fentanyl for tonsillectomy, an 8-year-old male patient complains of leg cramps in the recovery room and passing of dark color urine. The anesthesia attending is contacted. Vital signs are stable and there is no evidence of any rigidity or fever. What should be appropriate management of this patient?

a) Discharge to home and advise to drink plenty of clear fluids

b) Administer dantrolene

c) Provide aggressive hydration; send labs for serum electrolytes, serum and urine myoglobin and serum creatinine kinase level; and continue to monitor the patient

d) Arrange for urgent muscle biopsy

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Answer

Answer c.

This patient may have a undiagnosed myopathy and suffered from anesthesia induced rhabdomyolysis. Provide supportive therapy, send laboratory investigation and continue to monitor the patient. There is no history of rigidity or fever making diagnosis of MH unlikely. Further inquiry into delay in motor milestones or family history of neuromuscular disorder should be made. Urgent muscle biopsy is not indicated in this patient.

Notes

This question originally printed in the Pediatric Anesthesiology Review Topics kindle book series, and appears courtesy of Naerthwyn Press, LLC.

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