Murakami F, Harada K, Kaseno S, Yokota S, Kemmotsu O
Department of Anesthesiology, Hokkaido University School of Medicine, Sapporo.
Masui. 1992 Jun;41(6):988-91.
We have experienced a case of fulminant malignant hyperthermia who was a 63-year-old female weighing 44 kg. There was no particular past history nor family history. She underwent right mastoidectomy because of chronic otitis media. Her preoperative physical status was ASA I. She was premedicated with diazepam 10 mg and loxatigine 75 mg P.O. The induction was done with thiamylal 200 mg IV and fentanyl 0.1 mg IV followed by vecuronium 6 mg IV for endotracheal intubation. Intubation was easy and uneventful. Anesthesia was maintained with nitrous oxide 3 l.min-1, oxygen 3 l.min-1 and enflurane 2.0%. Seventy min after the induction of anesthesia, arterial blood gas analysis showed severe respiratory acidosis (PCO2: 63.2 mmHg, pH: 7.27) and it was improved with manual hyperventilation at that time. Pulse rate increased from 80 to 115 b.p.m. 20 minutes later. Then, the patient was ventilated with 100% oxygen, and anesthetic circuits and machine were exchanged for new units. Surgery was postponed. Muscle stiffness of upper extremities was observed and her temperature increased to a maximum of 38.9 degrees C. Surface cooling was started and dantrolene sodium 60 mg and furosemide 20 mg were given intravenously. The patient was transferred to the intensive care unit, and clinical signs improved gradually within one hour. Serum enzymes; CPK, LDH, GOT and GPT increased on the first postoperative day. On the 11 th postoperative day skeletal muscle biopsy was done under local anesthesia with 1% procaine and Ca-induced Ca-release rate test revealed positive for enflurane. This is the oldest patient of malignant hyperthermia reported in Japan.
我们遇到过一例暴发性恶性高热病例，患者为一名63岁女性，体重44千克。既往无特殊病史及家族史。因慢性中耳炎，她接受了右乳突切除术。其术前身体状况为美国麻醉医师协会（ASA）分级I级。术前给予口服地西泮10毫克和氯氮平75毫克。静脉注射硫喷妥钠200毫克和芬太尼0.1毫克进行诱导，随后静脉注射维库溴铵6毫克用于气管插管。插管顺利，无并发症。麻醉维持采用氧化亚氮3升/分钟、氧气3升/分钟和安氟醚2.0%。麻醉诱导70分钟后，动脉血气分析显示严重呼吸性酸中毒（二氧化碳分压：63.2毫米汞柱，pH值：7.27），当时通过手动过度通气得到改善。20分钟后，脉搏率从80次/分钟增加到115次/分钟。然后，患者用100%氧气通气，更换麻醉回路和麻醉机为新设备。手术推迟。观察到上肢肌肉僵硬，体温最高升至38.9摄氏度。开始体表降温，并静脉注射丹曲林钠60毫克和呋塞米20毫克。患者被转至重症监护病房，临床症状在一小时内逐渐改善。术后第一天血清酶（肌酸磷酸激酶、乳酸脱氢酶、谷草转氨酶和谷丙转氨酶）升高。术后第11天，在1%普鲁卡因局部麻醉下进行骨骼肌活检，钙诱导钙释放率试验显示对安氟醚呈阳性反应。这是日本报道的恶性高热患者中年龄最大的一例。
