title: Continuous veno-venous hemofiltration for massive rhabdomyolysis after malignant hyperthermia: report of 2 cases.
abstract: We present 2 cases of fulminant malignant hyperthermia (MH), complicated with massive rhabdomyolysis. The patients were successfully treated in the intensive care unit of our university teaching hospital, despite the lack of availability of dantrolene in our country, by early application of continuous veno-venous hemofiltration (CVVH). Both male patients developed fulminant malignant hyperthermia during anesthesia for oromaxillofacial surgery. CVVH was employed when the values of creatine phosphokinase (CPK), myoglobin (Mb), and lactate dehydrogenase (LDH) increased significantly. After emergency treatment and CVVH therapy, the values of CPK, Mb, and LDH in the blood plasma of the patients decreased significantly. The complications, including acute renal failure, disseminated intravascular coagulation, and acute respiratory distress syndrome were also treated without any obvious organ damage. Early detection and management are the keys to treat MH successfully. CVVH is a valuable therapeutic application in the initial/critical management of severe rhabdomyolysis. If these complications occur even with initial treatment with dantrolene, our experiences may be useful adjunctive treatments to consider.
authors.affiliation: Shanghai Jiao Tong University School of Medicine, Shanghai, China. fangshudong@sina.com.cn
authors.forename: Shudong
authors.initials: S
authors.lastname: Fang
authors.forename: Hui
authors.initials: H
authors.lastname: Xu
authors.forename: Yesen
authors.initials: Y
authors.lastname: Zhu
authors.forename: Hong
authors.initials: H
authors.lastname: Jiang
mesh_terms: D058186:Acute Kidney Injury / Q000628:therapy; D000293:Adolescent; D000328:Adult; D000766:Anesthesia, Dental / Q000009:adverse effects; D000768:Anesthesia, General / Q000009:adverse effects; D018686:Anesthetics, Intravenous / Q000009:adverse effects; D003402:Creatine Kinase / Q000097:blood; D004211:Disseminated Intravascular Coagulation / Q000628:therapy; D005283:Fentanyl / Q000009:adverse effects; D006440:Hemofiltration / Q000379:methods*; D006801:Humans; D007770:L-Lactate Dehydrogenase / Q000097:blood; D008297:Male; D008305:Malignant Hyperthermia / Q000150:complications*; D063166:Maxillary Osteotomy; D009211:Myoglobin / Q000097:blood; D010307:Parotid Neoplasms / Q000601:surgery; D015742:Propofol / Q000009:adverse effects; D012128:Respiratory Distress Syndrome / Q000628:therapy; D012206:Rhabdomyolysis / Q000628:therapy*
chemical_list: D018686:Anesthetics, Intravenous; D009211:Myoglobin; D007770:L-Lactate Dehydrogenase; D003402:Creatine Kinase; D005283:Fentanyl; D015742:Propofol