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This case report details the onset of masseter muscle rigidity, elevated creatine kinase levels, and rhabdomyolysis following a sevoflurane mask induction and succinylcholine administration in a 12-year-old boy. The patient had no family or personal history of neuromuscular disease or malignant hyperthermia. Hyperkalemia, metabolic acidosis, and rhabdomyolysis occurred within 75 minutes of masseter muscle rigidity. Subsequent to this event, it was recommended that the patient undergo a workup for neuromuscular disease and malignant hyperthermia with muscle biopsy. Until this workup is completed, the family should advise anesthesia providers that the patient is "malignant hyperthermia susceptible." Masseter muscle rigidity, elevated creatine kinase levels, and rhabdomyolysis will be thoroughly discussed in this article.
Keywords: Elevated creatine kinase, masseter muscle rigidity, rhabdomyolysis, succinylcholine.
Succinylcholine (SCh) is administered to facilitate airway management and is associated with many well-documented adverse effects. This case report outlines the development of masseter muscle rigidity (MMR), elevated creatine kinase (CK) levels, and rhabdomyolysis developing subsequent to the administration of SCh. On examination of the contemporary literature no case reports were found that illustrate the development of all 3 of these complications in a single patient following the administration of SCh. A case report by Shaaban et al1 reports the occurrence of rhabdomyolysis and elevated CK levels subsequent to the administration of SCh in a 9-year-old child. Pedrozzi et al2 discuss rhabdomyolysis after SCh was given to 2 otherwise healthy young boys. Flewellen and Nelson3 report MMR induced by SCh in 6 boys. Comprehensive discussion of these occurring together is both intriguing and important in detailing appropriate perioperative management.
Case Report
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