A 40 kg 9-year-old female...

A 40 kg 9-year-old female was planned for an elective expulsion of an enormous right anterior deltoid keloid scar. Her clinical history was significant for mild asthma. Medications included was regular inhaled fluticasone and salmeterol along with intermittent inhaled salbutamol as required for advanced asthma symptoms. In the days waving, she had an intermittent dry cough with no exercise limitation, dyspnoea, and fevers. Her preoperative physical examination demonstrated a gentle irregular wheeze in the right anterior basal lung field that was settled with salbutamol. She was continued with general anaesthesia for the later assessment. She had received 50 mg of propofol (Iv) and 50 μg of fentanyl (Iv) for induction and was successfully ventilated with a circle system during the apnoeic period. On rising up out of anesthesia 100 mg of propofol (Iv) was given following cessation of sevoflurane to facilitate removal of her LMA under deep sedation. The patient subsequently turned out to be difficult to ventilate with high airway pressures, hypoxia, and decreased air movement with reduced chest expansion. As an emergency crisis her anesthesia was deepened with a further 100 mg of propofol and ongoing manual ventilation was attempted with sevoflurane 8% on high flows of 100% oxygen. As this did not work on her ventilation, 50 mg of suxamethonium (iv) was administered with a fast improvement in ventilation, oxygenation, and airway pressures. Two hours later, the patient couldn’t walk independently and needed full support to stand. She had decreased knee reflexes bilaterally and a broad-based unsteady gait. Her tactile function, upper limb examination, and cranial nerve examination were completely unremarkable. To exclude salbutamol-instigated hypokalaemia as a possible cause of acute weakness, venous blood gas was requested, revealing a mild hypokalaemia of 3.3 mmol/L. Having excluded this as a cause, the working finding was suxamethonium-induced myalgia. She was kept for an observation of 3 hours until her symptoms improved.