Acute hypomagnesaemia causing intra-operative lower limb movements in a paraplegic patient, despite full neuromuscular blockade

Authors: OZARD, J.¹; MOSSDORF, P.¹; DOJA, A.²; WRITER, H.³; DOHERTY, D. R.

Source: Acta Anaesthesiologica Scandinavica, Volume 52, Number 7, August 2008 , pp. 1018-1020(3)

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Abstract:

Alterations in electrolyte homeostasis associated with major surgery, intravenous fluid therapy, malnutrition, and critical illness are common but usually non-specific. This case report describes the sudden onset of forceful rhythmic flexion movements in both lower limbs during scoliosis surgery in a 12-year-old paraplegic boy with spina bifida. These movements arose despite adequate depth of anaesthesia, complete neuromuscular blockade, and treatment of hypocalcaemia. They persisted post-operatively after reversal of neuromuscular blockade and emergence from anaesthesia. Hypomagnesaemia was identified and treated post-operatively which coincided with cessation of the movements. We deduce hypomagnesaemia to be the aetiology of this unusual clinical presentation. This report underscores the interdependency of Ca²⁺and Mg²⁺ homeostasis in excitable tissues and emphasizes that abnormalities observed in each cation should not be considered independently. In the perioperative care of spinal fusion patients, hypocalcaemia is a well-recognised and understood complication.

Keywords: Hypomagnesaemia; tetany

Document Type: Research article

DOI: http://dx.doi.org/10.1111/j.1399-6576.2008.01644.x

Affiliations: 1: Department of Anaesthesia, 2: Department of Paediatrics, Division of Neurology and 3: Department of Paediatrics, Division of Intensive Care, Children's Hospital of Eastern Ontario, University of Ottawa, ON, Canada

Publication date: 2008-08-01