Morota Tomoko, Endo Katsuya, Furuta Setsuo, Obara Shinju, Ohmuzo Hiroshi, Kaneko Toshikazu, Onuma Toshiyasu, Watanabe Kazuhiro
Department of Dental Anesthesiology, Aizu Chuo Hospital, Aizuwakamatsu.
Masui. 2007 Jul;56(7):826-30.
We experienced a case of the abortive malignant hyperthermia (MH) that had developed during operation. The patient was a 14-year-old girl, and plastic surgery was scheduled under general anesthesia. Serum creatine kinase (CK) levels were high with 505 IU x l(-1) at the preoperative examination. General anesthesia was induced with propofol and vecuronium bromide, and maintained with sevoflurane. Suddenly, sinus tachycardia of an uncertain cause and a rapid rise of end-tidal carbon dioxide (Et(CO2)) concentration were noticed. Since we suspected MH, we did cooling and hyperventilation and administered dantrolene sodium 2 mg x kg(-1) for the patient. As a result, the highest temperature remained at 37.6 degrees C. Serum CK levels increased most postoperative 18 hours later and it is improved gradually. As sevoflurane, promotes the CICR (calcium-induced calcium release) mechanism, the trigger of this case is probably sevoflurane. As for the symptom that makes us doubt MH first, there is a maked rapid rises of Et(CO2). Therefore, it is important monitor and recognize the first symptom of MH.
我们遇到了一例术中发生的未遂恶性高热（MH）病例。患者为一名14岁女孩，计划在全身麻醉下进行整形手术。术前检查时血清肌酸激酶（CK）水平较高，为505 IU×l⁻¹。采用丙泊酚和维库溴铵诱导全身麻醉，并用七氟醚维持。突然，发现原因不明的窦性心动过速和呼气末二氧化碳（Et(CO₂)）浓度迅速升高。由于我们怀疑是MH，于是对患者进行了降温、过度通气，并给予2 mg×kg⁻¹的丹曲林钠。结果，最高体温维持在37.6℃。血清CK水平在术后18小时升高至最高，随后逐渐改善。由于七氟醚可促进钙诱导钙释放（CICR）机制，该病例的诱因可能是七氟醚。至于最初让我们怀疑MH的症状，是Et(CO₂)的显著快速升高。因此，监测和识别MH的首发症状很重要。
