Anaesthetics
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Rhabdomyolysis: case report A 34-year-old woman developed rhabdomyolysis during induction or maintenance of anaesthesia with lidocaine, fentanyl, suxamethonium chloride and propofol for elective oesophagogastroduodenoscopy (EGD) and placement of Bravo oesophageal pH monitor. The woman, who had severe gastroesophageal reflux disease (GERD) with various concurrent conditions, presented for EGD and Bravo oesophageal pH monitor placement. Her outpatient medications included levothyroxine, esomeprazole and sumatriptan. Her anamnesis revealed that she had a caesarean section and an appendectomy and no problems related to anaesthesia was reported. She underwent general anaesthesia with rapid sequence intubation due to severity of her reflux symptoms. Her anaesthesia induction included lidocaine 50mg, fentanyl 100µg, suxamethonium chloride [succinylcholine] 80mg and propofol 150mg. The airway was secured and classic rapid sequence intubation was performed. Anaesthesia was maintained with infusion of propofol at 250 µg/kg/min [routes not stated]. The procedure lasted for 30 minutes. She received a total propofol dose of 485mg. She was extubated following the procedure. Her vital signs remained stable throughout the procedure and at her stay in post anaesthesia care unit. Two hours postoperatively, she reported diffuse muscle aches throughout her body and also passed blood tinged urine. Rhabdomyolysis was suspected. The woman started receiving a fluid bolus and was encouraged to hydrate by mouth. Laboratory studies and additional workup confirmed the diagnosis of rhabdomyolysis [durations of treatment to reactions onset not clearly stated]. She required admission to hospital and started receiving treatment with aggressive fluid hydration. On postoperative day 3, her lab parameters showed improvement with decreasing creatine kinase, AST and ALT. Her muscle aches had also completely resolved. During the hospital course, her laboratory parameters and vital signs remained stable. She was discharged on the same day with instructions to followup in one week. However, she was lost to follow-up. Tang JJ, et al. Severe rhabdomyolysis following an uncomplicated endoscopic procedure: A case report. Anaesthesia, Pain and Intensive Care 24: 354-357, No. 3, Jul-Sep 803518840 2020. Available from: URL: http://doi.org/10.35975/apic.v24i3.1285
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Reactions 5 Dec 2020 No. 1833
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