title: [Cardiac arrest during anesthesia induction with halothane and succinylcholine in an infant. Massive hyperkalemia and rhabdomyolysis in suspected myopathy and/or malignant hyperthermia].
abstract: This report describes a cardiac arrest that occurred in a 4-month-old infant during induction of anesthesia. During the administration of N2O/O2 and halothane via a face mask tachycardia was noted and rigor followed the application of succinylcholine for intubation. Shortly thereafter cardiac arrest occurred; 15 min later we found a profound metabolic acidosis as well as signs of rhabdomyolysis with a serum potassium level of 10.3 mmol/l and an increase in serum creatine kinase (CK). While performing cardiopulmonary resuscitation (CPR) and treating the acid-base imbalance and hyperkalemia, we administered--suspecting malignant hyperthermia (MH)--dantrolene. Approximately 60 min post-arrest we achieved stabilization of the vital signs. During the following hours the CK level rose to 99, 600 IU/l and myoglobinuria of 360,000 micrograms/l confirmed the extent of the rhabdomyolysis. The infant was discharged home without detectable sequelae after 2 1/2 weeks. Comparisons with corresponding case reports in the literature lead to the supposition that our patient suffered from a myopathy thus far undiagnosed. To what extent a MH episode may have contributed to the clinical picture cannot be determined at present. The spectrum of adverse reactions to volatile anesthetics and succinylcholine in patients with myopathic disorders is presented and discussed. As in other case reports, the dramatic course described here also demonstrates that in addition to CPR and treatment of the acid-base and electrolyte imbalances, administration of dantrolene should be considered at an early stage.
authors.affiliation: Abteilung für Anaesthesie und Intensivmedizin, Johanniter-Kinderklinik, Sankt Augustin.
authors.forename: J
authors.initials: J
authors.lastname: Mehler
authors.forename: H
authors.initials: H
authors.lastname: Bachour
authors.forename: F
authors.initials: F
authors.lastname: Simons
authors.forename: K
authors.initials: K
authors.lastname: Wolpers
mesh_terms: D000769:Anesthesia, Inhalation; D009202:Cardiomyopathies / Q000150:complications*; D006221:Halothane / Q000009:adverse effects*; D006323:Heart Arrest / Q000209:etiology*; D006801:Humans; D006947:Hyperkalemia / Q000209:etiology*; D007223:Infant; D008297:Male; D008305:Malignant Hyperthermia / Q000150:complications*; D012206:Rhabdomyolysis / Q000209:etiology*; D013390:Succinylcholine / Q000009:adverse effects*
chemical_list: D013390:Succinylcholine; D006221:Halothane
vernacular_title: Herzstillstand während der Narkoseeinleitung mit Halothan und Succinylcholin bei einem Säugling. Massive Hyperkaliämie und Rhabdomyolyse bei Verdacht auf Myopathie und/oder maligne Hyperthermie.