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LETTER TO THE EDITOR

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

Arkansas Childrens’ Hospital; University of Arkansas Medical Center; Little Rock, AR (Al-Takrouri) Batson Childrens’ Hospital; University of Mississippi Medical Center; Jackson, MS; jmayhew{at}anesthesia.umsmed.edu (Mayhew)

To the Editor:

We read with interest the article by Nathan et al. (1) concerning a hyperkalemic cardiac arrest in a child with unsuspected Duchenne muscular dystrophy. As the authors state in their discussion, children with undiagnosed Duchenne muscular dystrophy are at an increased risk when exposed to depolarizing muscle relaxants; however, the unexpected rhabdomyolysis associated with general anesthesia drugs is still a problem and no specific disease appears to be related to this phenomenon (2–4). Because of this, we disagree with the authors’ recommendation of routine preoperative screening of all patients for elevated serum creatine kinase. Although an elevated serum creatine kinase is highly sensitive for myopathies, it lacks specificity (4). Serum creatinine kinase may be elevated after trauma and heavy exercise. Universal screening can result in frequent and unnecessary delays in the operating room schedule and also lead to the "Ulysses Syndrome" of "mental and physical disorders which follow the discovery of a false positive result" (5).

Careful and thorough preanesthetic evaluation is essential in helping to identify undiagnosed myopathies, but as with the patient in this report and others (6), this method is not foolproof.

We agree with the authors that screening in the neonatal period may be helpful but will need a formal cost analysis before this can be accomplished.

References

1. Nathan A, Ganes A, Godinez RI, et al. Hyperkalemic cardiac arrest after cardiopulmonary bypass in a child with unsuspected Duchenne muscular dystrophy. Anesth Analg 2005;100:672–4.[Abstract/Free Full Text]
2. Medina KA, Mayhew JF. Generalized muscle rigidity and hypercarbia with halothane and isoflurane. Anesth Analg 1998;86:297–8.[Medline]
3. Maccario M, Fumagalli C, Dottori V, et al. The association between rhabdomyolysis and acute renal failure in patients undergoing cardiopulmonary by pass. J Cardiovas Surg 1996;37:153–9.[Medline]
4. Pedrozzi NE, Ranelii GP, Tomasetti R, et al. Rhabdomyolysis and anesthesia: a report of two cases and review of the literature. Pediatr Neurol 1996;15:254–7.[Web of Science][Medline]
5. Mercer R. The Ulysses syndrome. Can Med Assoc J 1972;106:122–3.[Medline]
6. Al-Takrouri H, Martin TW, Mayhew JF. Hyperkalemic cardiac arrest following succinylcholine administration: the use of extracorporeal membrane oxygenation in an emergency situation. J Clin Anesth 2004;16:449–51.[Medline]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Al-Takrouri, H. Articles by Mayhew, J. F. Search for Related Content PubMed PubMed Citation Articles by Al-Takrouri, H. Articles by Mayhew, J. F.