Case Report: Red Urine After Day Care Strabismus Surgery

Planning anesthesia of a child with a rare disease: useful tools

Up to 8,000 rare diseases are currently described in the scientific literature. The presence of a rare disease constitutes an additional challenge for the practitioner given its implications on the management of anesthesia. Moreover, it is not possible for an anesthesiologist to know them all especially as the sources of information are scattered. This narrative review aims at proposing pre-anesthetic evaluation clear tools to summarize the individual aspects of a known or suspected rare disease in a patient and to define an adapted anesthetic strategy. It also describes a decision-making process, called « the rare disease reflex », to guide the practitioner to quickly initiate diagnostic investigations in the presence of unusual perioperative clinical signs suggestive of an undiagnosed rare disease.

A suspected case of anesthesia-induced rhabdomyolysis in a child undergoing strabismus surgery

We report a case of acute rhabdomyolysis following general anesthesia for strabismus surgery in a previously healthy 11-year-old girl. The patient received a depolarizing muscle relaxant (succinylcholine) and halogenated volatile anesthetic agent (sevoflurane) during surgery. In rare cases, these classes of drugs can trigger malignant hyperthermia (MH) or anesthesia-induced rhabdomyolysis (AIR), which can cause significant morbidity and mortality if not recognized and treated promptly. Pathophysiology, early recognition, and special considerations in strabismus patients are discussed.