[Anesthetic-induced heart arrest. A case report of 2 infants with previously unrecognized muscular dystrophy].
We report two boys aged 4 and 10 months who suffered cardiac arrests after induction of anaesthesia. Both infants had no personal or family history of myopathy. In both cases anaesthesia was induced by inhalation with halothane and N2O/O2 (70/30). To facilitate tracheal intubation both were given succinylcholine after the administration of atropine. The 4-month-old developed muscle rigidity and cardiac arrest occurred immediately after tracheal intubation. Resuscitation was unsuccessful. Laboratory findings during resuscitation showed elevated serum potassium levels of more than 10 mmol/l and serum creatine phosphokinase 17.700 IU/l. Histopathologic examination of the skeletal muscle revealed congenital muscular dystrophy. In the older boy no muscle contractures were noted after administration of succinylcholine. He developed bradycardia that progressed to asystole 15 min after induction of anaesthesia. After 1 h of resuscitation a sinus rhythm could be established. The boy developed myoglobinuria and his serum creatine phosphokinase reached a maximum level of 45,000 IU/l on the 2nd day. The child survived and made a complete recovery. Two months later a muscle biopsy taken from the quadriceps showed marked muscular dystrophy. Duchenne's muscular dystrophy could be excluded. The most likely underlying reasons for these complications are discussed: anaesthesia-induced acute rhabdomyolysis or malignant hyperthermia.
Stelzner
J
J
Klinik für Anaesthesiologie und operative Intensivmedizin, Freie Universität Berlin.
Kretz
F J
FJ
Rieger
A
A
Reinhart
K
K
D000758:Anesthesia / Q000009:adverse effects*; D006323:Heart Arrest / Q000209:etiology*; D006801:Humans; D007223:Infant; D008297:Male; D008305:Malignant Hyperthermia / Q000150:complications; D009136:Muscular Dystrophies / Q000150:complications*; D012206:Rhabdomyolysis / Q000150:complications