[Anesthesia in familial hyperkalemic periodic paralysis].
A 53-year-old woman was scheduled for elective surgery of a L4-L5 lumbar disc prolapse. Preoperatively, she reported of a hereditary muscle disease in her family which could be identified as familial hyperkalaemic periodic paralysis. In patients with familial periodic paralysis, only limited information is available in the current anaesthesiological literature. This is especially true of the hyperkalaemic form which was separated from the hypokalaemic form in 1957. Most patients suffering from periodic paralysis will develop myotonic symptoms in time, but evidence is lacking that the incidence of malignant hyperthermia (MH) is higher than in normals. However, abnormalities of the electrocardiogram (ECG) due to changes in the potassium serum levels are not unusual, and the anaesthesiologist must be aware of cardiac arrhythmias. In the present case, the patient was anaesthetized using fentanyl, midazolam, and vecuronium, and ventilated with 66% nitrous oxide in oxygen. Radial artery blood pressure, end-tidal CO2, and nasopharyngeal temperature were monitored continuously. Surgery was completed after 2 hours with no abnormalities in the intraoperative course. Recovery from anaesthesia was uneventful. During the postoperative follow-up for 1 week, further attacks of paralysis, intermittent sodium-potassium imbalance of the muscle cell membrane appears to be the primary pathogenetic factor. In this special disease, prevention of carbohydrate depletion and the avoidance of muscle relaxants are recommended in the anaesthesiological literature. However, a specified regimen of general anaesthesia has not yet been outlined. In our special case, the use of anaesthetics deemed to be safe in MH susceptible patients produced an uneventful perioperative course.(ABSTRACT TRUNCATED AT 250 WORDS)
Thiel
A
A
Abteilung für Anästhesiologie und Operative Intensivmedizin, Justus-Liebig-Universität Giessen.
Wagner
M
M
Behr
R
R
Hempelmann
G
G
D000768:Anesthesia, General; D001786:Blood Glucose / Q000378:metabolism; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000503:physiopathology / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000601:surgery*; D008305:Malignant Hyperthermia / Q000503:physiopathology / Q000517:prevention & control; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D010245:Paralyses, Familial Periodic / Q000503:physiopathology*; D010976:Platelet Count; D011188:Potassium / Q000097:blood; D012964:Sodium / Q000097:blood
D001786:Blood Glucose; D012964:Sodium; D011188:Potassium
Anästhesie bei familiärer hyperkaliämischer periodischer Lähmung.