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PEDIATRIC ANESTHESIA

Hyperkalemic Cardiac Arrest After Cardiopulmonary Bypass in a Child with Unsuspected Duchenne Muscular Dystrophy

Aruna Nathan, MD^*, Arjunan Ganesh, MBBS^*, Rodolfo I. Godinez, MD, PhD^*, Susan C. Nicolson, MD^*, and William J. Greeley, MD^*

*Department of Anesthesia and Critical Care Medicine, The Children’s Hospital of Philadelphia; and Department of Anesthesia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania

Address correspondence and reprint requests to Arjunan Ganesh, MBBS, Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia, 34th St. and Civic Center Blvd., Philadelphia, PA 19104-4399. Address e-mail to ganesha{at}email.chop.edu.

Adverse reactions to volatile anesthetics and depolarizing muscle relaxants can occur in patients with Duchenne muscular dystrophy (DMD) resulting in acute rhabdomyolysis and hyperkalemia. We report a case of hyperkalemic cardiac arrest after cardiac surgery using cardiopulmonary bypass in a child with unsuspected DMD. Early diagnosis and management of hyperkalemia resulted in a successful outcome. Genetic testing confirmed the diagnosis of DMD. We recommend a thorough preoperative investigation, including creatine kinase estimation, in children with a history of unexplained motor delay.

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