Maeda Emi, Mori Yumiko, Amano Eizo, Akamatsu Tetsuya, Okada Toshiki
Department of Anesthesiology, Osaka National Organization Hospital, Osaka 540-0006.
Masui. 2010 Jul;59(7):914-7.
We experienced a case of the complications following glycerin enema which suggested malignant hyperthermia. A 73-year-old man with knee osteoarthritis was scheduled for total knee arthroplasty under general and epidural anesthesia. The patient received glycerin enema before surgery. After epidural catheterization, anesthesia was induced with thiopental, fentanyl, vecuronium and sevoflurane. The trachea was intubated and the patient was ventilated with sevoflurane-air-oxygen. Then, cola-like urine was drained and he became febrile up to 37.9 degrees C. Although there were no other symptoms suggesting malignant hyperthermia, the surgery was cancelled. We suspected not only hemolysis by the color of the serum and the blood chemistry, but also rhabdomyolysis by increased levels of serum creatine phosphokinase and myoglobin as well as urine myoglobin. He recovered uneventfully. On the third day, perirectal abscess and anal fissure were diagnosed, which were considered to be the cause of the fever. It is well-known that glycerin enema could cause hemolysis, but rabdomyolysis as a complication of glycerin enema has rarely been reported. We speculate that injection of hypertonic glycerin into the perirectal tissue could have caused rhabdomyolysis as well as hemolysis, which led to cola-like urine. The complications following glycerin enema can be incorporated to a differential diagnosis of malignant hyperthermia.
我们遇到了一例甘油灌肠后出现并发症的病例，提示恶性高热。一名73岁患有膝骨关节炎的男性计划在全身麻醉和硬膜外麻醉下行全膝关节置换术。患者在手术前接受了甘油灌肠。硬膜外导管置入后，用硫喷妥钠、芬太尼、维库溴铵和七氟醚诱导麻醉。气管插管后，患者用七氟醚-空气-氧气通气。随后，排出可乐样尿液，体温升至37.9摄氏度。尽管没有其他提示恶性高热的症状，但手术取消。我们不仅根据血清颜色和血液化学检查怀疑有溶血，还根据血清肌酸磷酸激酶、肌红蛋白水平升高以及尿肌红蛋白怀疑有横纹肌溶解。他恢复顺利。第三天，诊断出直肠周围脓肿和肛裂，认为这是发热的原因。众所周知，甘油灌肠可导致溶血，但甘油灌肠作为并发症导致横纹肌溶解的情况鲜有报道。我们推测向直肠周围组织注射高渗甘油可能导致了横纹肌溶解以及溶血，进而导致可乐样尿液。甘油灌肠后的并发症可纳入恶性高热的鉴别诊断。
