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[Malignant hyperthermia during emergency craniotomy: a case report]
Kenji Shigematsu1, Shinjiro Shono, Koichi Tanigawa
1Department of Anesthesiology, Fukuoka University School of Medicine, Fukuoka 814-0180.
Masui. the Japanese Journal of Anesthesiology
|August 13, 2003
Summary
A patient experienced a severe reaction during anesthesia, likely malignant hyperthermia, characterized by high temperature and potassium. Prompt dantrolene treatment rapidly lowered body temperature, suggesting its effectiveness in managing this anesthesia complication.
Area of Science:
- Anesthesiology
- Pharmacology
- Neurology
Background:
- General anesthesia involving suxamethonium and isoflurane can precipitate rare but severe adverse events.
- Acute epidural hematoma necessitates emergency surgical intervention, often under general anesthesia.
Observation:
- During craniotomy for epidural hematoma, an 18-year-old male patient exhibited significant increases in end-tidal carbon dioxide, body temperature, and serum potassium.
- These physiological changes suggest a potential hypermetabolic crisis, such as malignant hyperthermia.
Findings:
- Intravenous administration of dantrolene sodium led to a rapid decrease in the patient's body temperature.
- Postoperative serum creatine kinase levels were not significantly elevated.
- Muscle biopsy revealed evidence of increased calcium-induced calcium release, a hallmark of malignant hyperthermia.
Implications:
- This case highlights the importance of recognizing and rapidly treating potential malignant hyperthermia during emergency surgery.
- Dantrolene sodium is a crucial therapeutic agent for managing hypermetabolic crises triggered by certain anesthetic agents.
- Understanding the pathophysiology of increased calcium-induced calcium release is vital for anesthetic safety.