title: Exertional rhabdomyolysis and heat stroke: Beware of volatile anesthetic sedation.
abstract: In view of the enormous popularity of mass sporting events such as half-marathons, the number of patients with exertional rhabdomyolysis or exercise-induced heat stroke admitted to intensive care units (ICUs) has increased over the last decade. Because these patients have been reported to be at risk for malignant hyperthermia during general anesthesia, the intensive care community should bear in mind that the same risk of life-threatening rhabdomyolysis is present when these patients are admitted to an ICU, and volatile anesthetic sedation is chosen as the sedative technique. As illustrated by the three case studies we elaborate upon, a thorough diagnostic work-up is needed to clarify the subsequent risk of strenuous exercise, and the anesthetic exposure to volatile agents in these patients and their families. Other contraindications for the use of volatile intensive care sedation consist of known malignant hyperthermia susceptibility, congenital myopathies, Duchenne muscular dystrophy, and intracranial hypertension.
authors.affiliation: Karel Heytens, Department of Anesthesiology, University Hospital Antwerp, 2650 Edegem, Belgium.
authors.forename: Karel
authors.initials: K
authors.lastname: Heytens
authors.affiliation: Karel Heytens, Department of Anesthesiology, University Hospital Antwerp, 2650 Edegem, Belgium.
authors.forename: Jan
authors.initials: J
authors.lastname: De Bleecker
authors.affiliation: Karel Heytens, Department of Anesthesiology, University Hospital Antwerp, 2650 Edegem, Belgium.
authors.forename: Walter
authors.initials: W
authors.lastname: Verbrugghe
authors.affiliation: Karel Heytens, Department of Anesthesiology, University Hospital Antwerp, 2650 Edegem, Belgium.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Baets
authors.affiliation: Karel Heytens, Department of Anesthesiology, University Hospital Antwerp, 2650 Edegem, Belgium.
authors.forename: Luc
authors.initials: L
authors.lastname: Heytens
keywords: Congenital myopathies; Exertional rhabdomyolysis; Heat stroke; Inhalational anesthetics; Intensive care sedation; Malignant hyperthermia