Factors not associated with anaesthesia and surgery

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1. Predisposing factors that are not associated with anaesthesia include crush and burns injury, ischaemia, viral infections, polymyositis, heat stroke, marathon running, McArdle's syndrome (McMillan et al 1989),Taurius'syndrome, neuroleptic malignant syndrome, and carnitine palmityl transferase deficiency (Kelly et al 1989). Occasionally it has been reported following status epilepticus accompanied by lactic acidosis (Winocour et al 1989).

2. Drug overdose may be accompanied by rhabdomyolysis, and reports have included theophylline (Parr & Willatts 1991), ecstasy and other related amphetamines (Singarajah & Lavies 1992,Tehan et al 1993), cocaine and beta-2 adrenoreceptor agonists. In a study of cocaine users presenting to an emergency department,

24% had rhabdomyolysis, defined as a CK h

>1000 u l-1, although symptoms were often g o absent (Welch et al 1991). Massive 3

rhabdomyolysis and acute renal failure has been y reported. Rhabdomyolysis, acute renal failure s and compartment syndrome have been described in young alcoholics undergoing treatment with benzodiazepines (Rutgers et al 1991). Rhabdomyolysis and acute renal failure occurred from a beta-2 adrenoreceptor agonist terbutaline (Blake & Ryan 1989), secondary to intense beta receptor stimulation.

3. Pre-existing conditions in which rhabdomyolysis may be precipitated during anaesthesia include malignant hyperthermia myopathy, Duchenne and Becker muscular dystrophies, myotonia congenita, spinal muscle atrophy, Guillain—Barre syndrome (Scott et al 1991), burns, and polyneuropathy.

4. The CK levels are greatly increased and the passage of dark brown urine, positive for blood on reagent strip, but with no RBCs on microscopy, is suggestive of the diagnosis. Myoglobin levels are increased, but only in the early stages.

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