[Case of malignant hyperthermia in which treatment was carried out smoothly].
We experienced a case of the abortive malignant hyperthermia (MH) that had developed during operation. The patient was a 14-year-old girl, and plastic surgery was scheduled under general anesthesia. Serum creatine kinase (CK) levels were high with 505 IU x l(-1) at the preoperative examination. General anesthesia was induced with propofol and vecuronium bromide, and maintained with sevoflurane. Suddenly, sinus tachycardia of an uncertain cause and a rapid rise of end-tidal carbon dioxide (Et(CO2)) concentration were noticed. Since we suspected MH, we did cooling and hyperventilation and administered dantrolene sodium 2 mg x kg(-1) for the patient. As a result, the highest temperature remained at 37.6 degrees C. Serum CK levels increased most postoperative 18 hours later and it is improved gradually. As sevoflurane, promotes the CICR (calcium-induced calcium release) mechanism, the trigger of this case is probably sevoflurane. As for the symptom that makes us doubt MH first, there is a maked rapid rises of Et(CO2). Therefore, it is important monitor and recognize the first symptom of MH.
Morota
Tomoko
T
Department of Dental Anesthesiology, Aizu Chuo Hospital, Aizuwakamatsu.
Endo
Katsuya
K
Furuta
Setsuo
S
Obara
Shinju
S
Ohmuzo
Hiroshi
H
Kaneko
Toshikazu
T
Onuma
Toshiyasu
T
Watanabe
Kazuhiro
K
D000293:Adolescent; D000768:Anesthesia, General; D018685:Anesthetics, Inhalation / Q000009:adverse effects*; D003620:Dantrolene / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D008305:Malignant Hyperthermia / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D008738:Methyl Ethers / Q000009:adverse effects*; D016343:Monitoring, Intraoperative; D000077149:Sevoflurane
D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D000077149:Sevoflurane; D003620:Dantrolene