Dexamethasone/general anaesthetics/suxamethonium chloride
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Rhabdomyolysis: case report A 32-year-old woman developed rhabdomyolysis following treatment with propofol and sevoflurane as a general anaesthesia along with dexamethasone and suxamethonium chloride [not all routes, dosages and indications stated]. The woman, who had complaints of bloody stools, dysphagia and abdominal pain, underwent an esophagogastroduodenoscopy and colonoscopy in an outpatient surgical center. She received IV dexamethasone 4mg, ondansetron and lidocaine during the procedure. General anaesthesia was started due to her history of morbid obesity and asthma. She was intubated, and was administered suxamethonium chloride [succinylcholine] 100mg. The anaesthesia was induced and maintained with propofol 300mg in two divided doses and sevoflurane. She had recovery from spontaneous ventilation, had normal BP and temperature following an uneventful procedure. A mild reflux, colonic polyps and erosive gastritis, with biopsy evidence of Helicobacter pylori [aetiologies not stated] was noted. She developed musculoskeletal pain after approximately 33 hours following the procedure. She described the pain as constant, diffuse tenderness, 5/10 intensity and progressive weakness to the point of requiring wheelchair and a walker. A diagnosis of non-traumatic rhabdomyolysis was made, and she was hospitalised to the internal medicine service. Her history was significant for respiratory tract infections, asthma, morbid obesity, thromboembolism of leg and anxiety. She denied alcohol use and was a former smoker (quit smoking in 2012). Her outpatient medications were limited to an albuterol for wheezing, and magnesium citrate was used as directed in preparation for the colonoscopy. Her physical examination was normal besides musculoskeletal tenderness. The woman was treated with sodium chloride [normal saline], accompanied by pain management with ketorolac, morphine, hydrocodone and paracetamol [acetaminophen]. Twenty-six hours after IV fluids administration, her creatine kinase (CK) level decreased. She reported mild to moderate pain, responsive to paracetamol, with ameliorated ability to move extremities. Later that day, she was discharged on paracetamol and instructed to hydrate orally. Follow-up of laboratory findings 6 days following hospitalisation showed a normal CK. The rhabdomyolysis was considered to have developed secondary to propofol, sevoflurane, dexamethasone and suxamethonium chloride. Barrons RW, et al. Succinylcholine-Induced Rhabdomyolysis in Adults: Case Report and Review of the Literature. [Review]. Journal of Pharmacy Practice 33: 102-107, No. 803514351 1, Feb 2020. Available from: URL: http://doi.org/10.1177/0897190018795983
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Reactions 14 Nov 2020 No. 1830
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