Maxillofacial Plastic and Reconstructive Surgery

Korean Association of Maxillofacial Plastic and Reconstructive Surgeons (대한악안면성형재건외과학회)
권호 표지

MALIGNANT HYPERTHERMIA

악교정 수술 중 발생한 지연성 악성 고열증의 치료

  • Oh, Sung-Hwan (Department of Oral and Maxillofacial Surgery, School of Dentistry) ;
  • Min, Seung-Ki (Department of Oral and Maxillofacial Surgery, School of Dentistry) ;
  • Kwon, Kyung-Hwan (Department of Oral and Maxillofacial Surgery, School of Dentistry) ;
  • Jo, Pil-Kwy (Department of Oral and Maxillofacial Surgery, School of Dentistry) ;
  • Song, Yun-Kang (Department of Anesthesiology and Pain Medicine, School of Medicine, Wonkwang University)
  • 오승환 (원광대학교 치과대학 구강악안면외과학교실) ;
  • 민승기 (원광대학교 치과대학 구강악안면외과학교실) ;
  • 권경환 (원광대학교 치과대학 구강악안면외과학교실) ;
  • 조필귀 (원광대학교 치과대학 구강악안면외과학교실) ;
  • 송윤강 (원광대학교 의과대학 마취과학교실)
  • Published : 2005.07.30
Download PDF
⟨ Previous Next ⟩

Abstract

Malignant hyperthermia is a catastrophic, hypermetabolic syndrome that arises in susceptible individuals when they are exposed to certain inhalational anesthetics or muscle relaxants. It is characterized by hyperthermia, tachycardia, acidosis, and muscle rigidity. It has been noted that the majority of cases of malignant hyperthermia are fatal unless early diagnosis and treatment are performed. We experienced a 24 year old male Malignant hyperthermia presented for orthognathic surgery under $O_2-N_2O$-sevoflurane anesthesia without succinylcholine. Two half hours after induction, tachycardia developed and was followed by unstable blood pressure and hyperpyrexia. Anesthesia was terminated and vigorous emergency treatment was attempted. The patient was treated by the intravenous administration of dantrolene sodium. The diagnosis of an acute malignant hyperthermia reaction by clinical criteria can be difficult because of the nonspecific nature and variable incidence of many of the clinical signs and laboratory findings. So the malignant hyperthermia clinical grading scale is recommended for use as an aid to the objective definition of this disease. This clinical grading system provides a new and comprehensive clinical case definition for the malignant hyperthermia syndrome. We recently encountered a case of delayed malignant hyperthermia during sevoflurane anesthesia that was successfully treated by the intravenous administration of dantrolene sodium. In conclusion, exposure to sevoflurane should be avoided in patients thought to be susceprible to malignant hyperthermia.

Keywords

References

  1. Miller RD : Anesthesia. 5th edition. Gronert GA, Antognini JFm, Pessah IN. pp1033
  2. Denborough MA, Lovell RRH : Anesthetic deaths in a family. [Letter] Lancet 2 : 45, 1960
  3. Ellis FR, Halsall PJ, Christian As : Clinical presentation of suspected malignant hyperthemia during anesthesia in 402 probands. anesthesia 45 : 838, 1990 https://doi.org/10.1111/j.1365-2044.1990.tb14566.x
  4. Allen GC, LArach MG, Kunselman AR : The sensitivity and specificity of the caffeine-halothane contracture test : A report From the North American malignant hyperthermia registry. anesthesiology 88 : 579, 1998 https://doi.org/10.1097/00000542-199803000-00006
  5. Rosenberg H. Malignant Hyperthermia syndrome. Anesth Anal 56 : 456, 1977
  6. Otsuka, Komura Y, Mayumi T, Yamamura T, Kemmotsu, Mukaida K : Malignant hyperthermia during sevoflurane anesthesia in a child with central core diseas. Anesthesiology 75 : 699, 1991 https://doi.org/10.1097/00000542-199109001-00698
  7. Ochiai R, Toyoda Y, Nishio I, Takaeda J, Sekiguchi H, Fukushima K et al. : Possible association of malignant hyperthermia with sevoflurane anesthesia. Anesth Analg 87 : 425, 1992 https://doi.org/10.1097/00000539-199808000-00036
  8. Maeda H, Iranami H, Hatano Y : Delayed recovery from muscle weakness due to malignat hyperthemia during sevoflurane anesthesia. Anesthesiology 87 : 425, 1997 https://doi.org/10.1097/00000542-199708000-00031
  9. Wedal DJ, Gammel SA, Milde JH, Iaizzo PA : Delayed onset of malignant hyperthermia induced by isoflurane and desflurane compared with halothane in susceptible swine. Anesthesiology 78 : 1138, 1993 https://doi.org/10.1097/00000542-199306000-00018
  10. Snoeck MJM, Gielen A, Tangerman J : Contractures in skeletal patients after in vitro exposure to sevoflurane. Acata Anaesthesiol Scand. Mar;44(3) : 334, 2000 https://doi.org/10.1034/j.1399-6576.2000.440320.x
  11. Larach MG : Standardization of the caffeine halothane muscle contracture test. Anesth Analog 69 : 511, 1989
  12. The Europran Malignant Hyperpyrexia Group : A protocol for the investigation of malignat hyperpyrexia (MH) susceptibility. Br J Anaesth 56 : 1267, 1984 https://doi.org/10.1093/bja/56.11.1267
  13. Hopkin PM, Ellis FR, Halsall PJ : Comparison of in vitro contracture testing with ryanodine, halothane and caffeine in malignant hyperthermia and other neromuscular disorder. Br J Anaesth 70 : 397, 1993 https://doi.org/10.1093/bja/70.4.397
  14. Larach MG, Localio AR, Allen GC : A clinical grading scale the predict malignant hyperthermia susceptibility. Anesthesiology 80 : 771, 1994 https://doi.org/10.1097/00000542-199404000-00008
  15. Pruen BR, Mickelson JR, Roghair TJ : Effect of propofol on Ca2+ regulation by malignant hyperthermia - susceptible muscle membranes. Anesthesiology 1274, 1995 https://doi.org/10.1097/00000542-199505000-00023
  16. Gronert GA, Milde JH : Variations in onset of porcine malignant hyperthermia. Anesth Analg 60 : 499, 1982
  17. Hopkins PM: Malignant hyperthermia: advances in clinical management and diagnosis. Br J Anaesth 85 : 118, 2000 https://doi.org/10.1093/bja/85.1.118
  18. Davies RM Packer KJ : Malignant hyperpyrexia-two case reports. Br J Anaesth 41 : 703, 1969 https://doi.org/10.1093/bja/41.8.703
  19. Larach MG, Rosenberg H Larach DR : Prediction of malignant hyperthermia susceptibility by clinical signs. Anesthesiology 66 : 547, 1987 https://doi.org/10.1097/00000542-198704000-00017
  20. Payen JF, Bosson JL : Improved noninvasive diagnostic testing for malignant hyperthermia susceptibility from a combination of metabolites determined in vitro with 31P-magnetic resonance spectroscopy. Anesthesiology 78 : 848, 1993 https://doi.org/10.1097/00000542-199305000-00007