From the Guidelines
Muscle relaxants are not recommended for the treatment of rhabdomyolysis, as they do not address the underlying pathophysiology of the disease and may even exacerbate the condition in certain cases, such as with the use of depolarizing muscle relaxants like succinylcholine, which can cause fatal reactions in patients with Duchenne muscular dystrophy 1. The primary treatment for rhabdomyolysis focuses on aggressive intravenous fluid administration to maintain urine output, prevent acute kidney injury, and help flush out myoglobin from the kidneys. Some key points to consider in the management of rhabdomyolysis include:
- Aggressive intravenous fluid administration, typically with isotonic saline at rates of 200-300 mL/hour initially
- Monitoring electrolytes, particularly potassium, calcium, and phosphate
- Treating hyperkalemia if present
- Considering urinary alkalinization in severe cases
- Monitoring for complications such as compartment syndrome, acute kidney injury, and electrolyte abnormalities throughout treatment In specific cases where rhabdomyolysis is caused by severe muscle spasms, seizures, or agitation, short-term use of benzodiazepines like diazepam (5-10 mg IV) may be appropriate to control these symptoms, as suggested by the most recent guidelines on muscle relaxants and reversal in anesthesia 1. However, the use of muscle relaxants should be approached with caution, and the benefits and risks should be carefully weighed in each individual case. It is also important to note that the use of certain muscle relaxants, such as benzylisoquinoline muscle relaxants (atracurium/cisatracurium), may be recommended in cases of renal or hepatic failure, as they have a more predictable pharmacokinetic profile in these patients 1. Ultimately, the management of rhabdomyolysis should be tailored to the individual patient's needs and underlying condition, and should prioritize the prevention of complications and the maintenance of adequate hydration and electrolyte balance.
From the Research
Treatment of Rhabdomyolysis
- The primary treatment for rhabdomyolysis involves early and aggressive fluid resuscitation to restore renal perfusion and increase urine flow 2.
- There is no mention of muscle relaxants as a recommended treatment for rhabdomyolysis in the provided studies.
- However, some studies suggest that certain medications, such as succinylcholine, can induce rhabdomyolysis in adults 3.
- In cases where rhabdomyolysis is caused by inflammatory myopathies, such as polymyositis, treatment with immunosuppressive medications like steroids may be effective 4.
Use of Muscle Relaxants
- There is limited evidence to support the use of muscle relaxants in the treatment of rhabdomyolysis.
- One study suggests that succinylcholine, a type of muscle relaxant, can induce rhabdomyolysis in adults, especially when combined with halogenated anesthesia 3.
- However, this study does not provide evidence on the use of muscle relaxants as a treatment for rhabdomyolysis.
Recommendations
- Early and aggressive fluid resuscitation is the primary treatment for rhabdomyolysis 5, 2, 6.
- In cases where rhabdomyolysis is caused by inflammatory myopathies, treatment with immunosuppressive medications like steroids may be effective 4.
- There is no evidence to support the routine use of muscle relaxants in the treatment of rhabdomyolysis.