Exertional rhabdomyolysis and heat stroke: Beware of volatile anesthetic sedation

doi:10.5492/wjccm.v6.i1.21

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World Journal of Critical Care Medicine

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World J Crit Care Med. Feb 4, 2017; 6(1): 21-27
Published online Feb 4, 2017. doi: 10.5492/wjccm.v6.i1.21

Exertional rhabdomyolysis and heat stroke: Beware of volatile anesthetic sedation

Karel Heytens, Jan De Bleecker, Walter Verbrugghe, Jonathan Baets, Luc Heytens

Karel Heytens, Department of Anesthesiology, University Hospital Antwerp, 2650 Edegem, Belgium

Jan De Bleecker, Department of Neurology, AZ Sint-Lucas, 9000 Ghent, Belgium

Jan De Bleecker, Department of Neurology, University Hospital Ghent, 9000 Ghent, Belgium

Walter Verbrugghe, Department of Intensive Care, University Hospital Antwerp, 2650 Edegem, Belgium

Jonathan Baets, Department of Neurology, University Hospital Antwerp, 2650 Edegem, Belgium

Jonathan Baets, Laboratory of Neurogenetics and Biobank, Institute Born-Bunge, University of Antwerp, 2610 Wilrijk, Belgium

Luc Heytens, MH Research Unit, University of Antwerp, 2610 Wilrijk, Belgium

Luc Heytens, Departments of Anesthesiology and Neurology, University Hospital Antwerp, 2650 Edegem, Belgium

Author contributions: Heytens K is the main author of the manuscript; De Bleecker J and Baets J provided information about the different cases and reviewed the manuscript; Verbrugghe W helped with his experience on volatile anesthetic sedation; Heytens L designed the aim of the manuscript and acted as co-writer.

Conflict-of-interest statement: The authors have no interests with the manufacturers of the AnaConDa^R or Mirus^TM devices. Heytens L is a medical expert with Norgine NV, manufacturer of Dantrium^R.

Correspondence to: Luc Heytens, MD, PhD, MH Research Unit, University of Antwerp, Campus Drie Eiken, 2610 Wilrijk, Belgium. luc.heytens@uantwerpen.be

Telephone: +32-34-433926

Received: June 28, 2016
Peer-review started: July 1, 2016
First decision: September 5, 2016
Revised: October 21, 2016
Accepted: November 16, 2016
Article in press: November 17, 2016
Published online: February 4, 2017
Processing time: 207 Days and 20.4 Hours

Core Tip

Core tip: Recent research has shown that a substantial proportion of patients with exercise-induced heatstroke harbor mutations in the ryanodine-receptor one gene on Chromosome 19 (RYR1), encoding for the principal calcium-release channel in striated muscle. These same mutations are known to result in a massively increased calcium-conductivity and life-threatening rhabdomyolysis when malignant hyperthermia (MH) susceptible patients are exposed to volatile anesthetics during general anesthesia. In view of this, exposure to volatile anesthetic sedation - an emerging trend in intensive care units - is contraindicated, not only in patients with known MH susceptibility and other congenital myopathies, but also in patients admitted because of exertional rhabdomyolysis and heatstroke.