Abstract
We report an adult case of rhabdomyolysis with creatine kinase (CK) elevation and myoglobinuria while continuous propofol infusion for sedation. A 35 year-old, 100kg weight, 190cm height man with diabetes mellitus was admitted to our hospital for nausea and vomiting. He became apneic after MRI study, then was intubated and resuscitative effort took place on the way to ICU. He was diagnosed as cerebellar infarction and underwent suboccipital external decompression without delay. Genaral anesthesia was maintained with nitrous oxide, oxygen, sevoflurane, fentanyl and vecuronium. The patient returned to ICU after the four hours surgery. Propofol was infused continuously at 3mg·kg-1·hr-1 from the first postoperative day (1 POD) to control his delirium but was discontinued because of serum CK elevation up to 2, 381U·l-1 on 3 POD, and 2, 334U·l-1 on 4 POD respectively compared with 119U·l-1 as preoperative value. Since malignant hyperthermia was not likely, dantrolene was not given and his body temperature fluctuated in the range between 36.2°C and 38.7°C. The patient was conclusively diagnosed as rhabdomyolysis by reason of CK elevation and myoglobinuria (404ng·ml-1 at 4 POD). His serum CK and urinary myoglobin concentration returned to normal about one month after when he left the hospital. It remains unclear how propofol infusion affected development of rhabdomyolysis but we suggest that you should check serum CK level while you administer propofol continuously as a sedative to prevent a patient from propofol-induced rhabdomyolysis.
