title: Postoperative neuroleptic malignant syndrome that occurred repeatedly in a patient with cerebral palsy.
abstract: A wide variety of neuroleptic agents are associated with neuroleptic malignant syndrome (NMS). However, the association between general anesthesia and NMS is uncertain. We report a case of a patient with cerebral palsy, who showed signs of NMS only after repeated general anesthesia. The patient received general anesthesia three times in a period of 9 months. The first anesthetic passed uneventfully. NMS symptoms were observed only after the second and third anesthetics. The NMS was effectively treated with IV dantrolene and the patient recovered on both occasions. Inhalational anesthetics, muscle relaxants and fentanyl were suspected as possible triggering factors for NMS. After examining the three anesthesia records and previous publications, we surmized that a nondepolarizing muscle relaxant was associated with NMS in this patient.
authors.affiliation: Department of Anaesthesia, Otsu Red Cross Hospital, Otsu, Japan.
authors.forename: Naohisa
authors.initials: N
authors.lastname: Tsuchiya
authors.forename: Eri
authors.initials: E
authors.lastname: Morimura
authors.forename: Tetsuji
authors.initials: T
authors.lastname: Hanafusa
authors.forename: Tetsutaro
authors.initials: T
authors.lastname: Shinomura
mesh_terms: D000768:Anesthesia, General; D014150:Antipsychotic Agents / Q000009:adverse effects*; D001831:Body Temperature / Q000187:drug effects; D002547:Cerebral Palsy / Q000601:surgery*; D002648:Child; D003402:Creatine Kinase / Q000097:blood / Q000187:drug effects; D003620:Dantrolene / Q000627:therapeutic use; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D009125:Muscle Relaxants, Central / Q000627:therapeutic use; D009459:Neuroleptic Malignant Syndrome / Q000097:blood* / Q000209:etiology / Q000517:prevention & control; D011184:Postoperative Period; D012008:Recurrence; D012307:Risk Factors
chemical_list: D014150:Antipsychotic Agents; D009125:Muscle Relaxants, Central; D003402:Creatine Kinase; D003620:Dantrolene