Malignant Hyperthermia during Thoracoscopic Pulmorrhaphy in a 70-Year-Old Man
Malignant hyperthermia (MH) is a rare but potentially fatal complication that may develop under general anesthesia (GA) and is rarely reported in elderly patients. We encountered a case of mild-onset MH in a 70-year-old patient who was receiving an elective thoracoscopic pulmorrhaphy and had a histo...
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| Language: | English |
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Wiley
2014-01-01
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| Series: | Case Reports in Anesthesiology |
| Online Access: | http://dx.doi.org/10.1155/2014/250502 |
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| author | Michihiro Sakai Noriko Murakami Yuji Kitamura Shin Sato Hiroshi Iwama Akira Nomura |
| author_facet | Michihiro Sakai Noriko Murakami Yuji Kitamura Shin Sato Hiroshi Iwama Akira Nomura |
| author_sort | Michihiro Sakai |
| collection | DOAJ |
| description | Malignant hyperthermia (MH) is a rare but potentially fatal complication that may develop under general anesthesia (GA) and is rarely reported in elderly patients. We encountered a case of mild-onset MH in a 70-year-old patient who was receiving an elective thoracoscopic pulmorrhaphy and had a history of several GA procedures. Anesthesia was induced with propofol, fentanyl, and rocuronium and maintained with sevoflurane and remifentanil. His body temperature (BT) was 37.9°C after induction. During the procedure, the end-tidal CO2 (ETCO2) increased steadily to 47–50 mmHg, presumably in response to the single lung ventilation. At the end, BT was 38.1°C and ETCO2 was 47 mmHg under spontaneous breathing. After extubation, the patient wheezed on inspiration and expiration, and his trachea was reintubated. Sixty minutes after surgery, BT increased to 40.5°C and the arterial blood gas analysis showed severe metabolic acidosis. Based on these findings, MH was suspected and a bolus dose of dantrolene was administered. He responded to the dantrolene, and no complications or recurrence of MH was observed postoperatively. In this patient, the initial signs of MH were so subtle that making the diagnosis of MH was difficult. A high degree of suspicion is necessary to prevent a fulminant MH crisis. |
| format | Article |
| id | doaj-art-630ca547607c499dba949d950a296386 |
| institution | Kabale University |
| issn | 2090-6382 2090-6390 |
| language | English |
| publishDate | 2014-01-01 |
| publisher | Wiley |
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| series | Case Reports in Anesthesiology |
| spelling | doaj-art-630ca547607c499dba949d950a2963862025-02-03T01:09:34ZengWileyCase Reports in Anesthesiology2090-63822090-63902014-01-01201410.1155/2014/250502250502Malignant Hyperthermia during Thoracoscopic Pulmorrhaphy in a 70-Year-Old ManMichihiro Sakai0Noriko Murakami1Yuji Kitamura2Shin Sato3Hiroshi Iwama4Akira Nomura5Department of Anesthesiology, Fujisawa Shonandai Hospital, 2345 Takakura, Fujisawa, Kanagawa 252-0802, JapanDepartment of Anesthesiology, Kimitsu Chuo Hospital, 1010 Sakurai, Kisarazu, Chiba 292-8535, JapanDepartment of Anesthesiology, Chiba University School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8677, JapanDepartment of Anesthesiology, Chiba University School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8677, JapanDepartment of Anesthesiology, Kimitsu Chuo Hospital, 1010 Sakurai, Kisarazu, Chiba 292-8535, JapanDepartment of Anesthesiology, Kimitsu Chuo Hospital, 1010 Sakurai, Kisarazu, Chiba 292-8535, JapanMalignant hyperthermia (MH) is a rare but potentially fatal complication that may develop under general anesthesia (GA) and is rarely reported in elderly patients. We encountered a case of mild-onset MH in a 70-year-old patient who was receiving an elective thoracoscopic pulmorrhaphy and had a history of several GA procedures. Anesthesia was induced with propofol, fentanyl, and rocuronium and maintained with sevoflurane and remifentanil. His body temperature (BT) was 37.9°C after induction. During the procedure, the end-tidal CO2 (ETCO2) increased steadily to 47–50 mmHg, presumably in response to the single lung ventilation. At the end, BT was 38.1°C and ETCO2 was 47 mmHg under spontaneous breathing. After extubation, the patient wheezed on inspiration and expiration, and his trachea was reintubated. Sixty minutes after surgery, BT increased to 40.5°C and the arterial blood gas analysis showed severe metabolic acidosis. Based on these findings, MH was suspected and a bolus dose of dantrolene was administered. He responded to the dantrolene, and no complications or recurrence of MH was observed postoperatively. In this patient, the initial signs of MH were so subtle that making the diagnosis of MH was difficult. A high degree of suspicion is necessary to prevent a fulminant MH crisis.http://dx.doi.org/10.1155/2014/250502 |
| spellingShingle | Michihiro Sakai Noriko Murakami Yuji Kitamura Shin Sato Hiroshi Iwama Akira Nomura Malignant Hyperthermia during Thoracoscopic Pulmorrhaphy in a 70-Year-Old Man Case Reports in Anesthesiology |
| title | Malignant Hyperthermia during Thoracoscopic Pulmorrhaphy in a 70-Year-Old Man |
| title_full | Malignant Hyperthermia during Thoracoscopic Pulmorrhaphy in a 70-Year-Old Man |
| title_fullStr | Malignant Hyperthermia during Thoracoscopic Pulmorrhaphy in a 70-Year-Old Man |
| title_full_unstemmed | Malignant Hyperthermia during Thoracoscopic Pulmorrhaphy in a 70-Year-Old Man |
| title_short | Malignant Hyperthermia during Thoracoscopic Pulmorrhaphy in a 70-Year-Old Man |
| title_sort | malignant hyperthermia during thoracoscopic pulmorrhaphy in a 70 year old man |
| url | http://dx.doi.org/10.1155/2014/250502 |
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