title: Malignant hyperthermia developing during esophageal resection in an 82-year-old man.
abstract: Malignant hyperthermia (MH) is a rare but fatal complication that develops under general anesthesia. Reports on MH in patients over the age of 80 years are unusual. We experienced a case of MH in an 82-year-old patient during esophageal resection. Anesthesia was induced with propofol and succinylcholine, and maintained with sevoflurane. Neither masseter spasm nor rigidity of the limbs was seen during induction. Body temperature (BT) at induction was 36.0 degrees C. Three hours after incision, the level of end-tidal CO2 was elevated to 55 mmHg. We assumed that the rise in end-tidal CO2 had occurred due to secretions in the airway. However, the BT, which had risen at 3 h after incision, continued to rise, and about 60 min later, the BT exceeded 39.0 degrees C. A rise of more than 0.5 degrees C in less than 15 min was seen, and MH was suspected. With dantrolene administration, the BT decreased from 40.9 degrees C at maximum to 37.7 degrees C. With continuous infusion of dantrolene when the patient was transferred to the intensive care unit (ICU), BT remained within the normal range. The next day re-operation was performed, without further complications or recurrence of MH during the postoperative period. Because it is necessary to initiate treatment in the early stage of MH, as soon as possible, although MH prevalence is low in the elderly, it is important to suspect MH when hypercapnia and/or hyperthermia are seen.
authors.affiliation: Department of Anesthesiology, Kawasaki Municipal Kawasaki Hospital, Kawasaki, Japan.
authors.forename: Norihito
authors.initials: N
authors.lastname: Nakamura
authors.forename: Tomomi
authors.initials: T
authors.lastname: Ueda
authors.forename: Reiri
authors.initials: R
authors.lastname: Ishikawa
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Tasaka
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Fukuuchi
authors.forename: Nobukazu
authors.initials: N
authors.lastname: Sato
mesh_terms: D000369:Aged, 80 and over; D000768:Anesthesia, General; D001784:Blood Gas Analysis; D001831:Body Temperature / Q000187:drug effects / Q000502:physiology; D002245:Carbon Dioxide / Q000378:metabolism; D003620:Dantrolene / Q000627:therapeutic use; D004938:Esophageal Neoplasms / Q000601:surgery; D004947:Esophagus / Q000601:surgery*; D006801:Humans; D008297:Male; D008305:Malignant Hyperthermia / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*; D009125:Muscle Relaxants, Central / Q000627:therapeutic use
chemical_list: D009125:Muscle Relaxants, Central; D002245:Carbon Dioxide; D003620:Dantrolene