St. Vincent Indianapolis Hospital, 2001 West 86th Street, Indianapolis, IN 46260, USA.
Am J Health Syst Pharm. 2012 Jul 1;69(13):1128-34. doi: 10.2146/ajhp110306.
Two cases of malignant hyperthermia suspected to be related to the use of a nondepolarizing neuromuscular blocker are reported.
A pharmacogenetic disorder that may occur in as many as 1 in 3000 anesthesia procedures, malignant hyperthermia has been linked to the use of certain anesthetic gases and depolarizing neuromuscular blocking agents (e.g., succinylcholine). Although nondepolarizing neuromuscular blockers were cited as contributing to the development of malignant hyperthermia in a small number of published reports, the agents are generally considered safe for use in at-risk patients. Here investigators report two cases in which the nondepolarizing agent rocuronium is thought to have triggered malignant hyperthermia in patients with no known history of the disorder. In one case, a critically ill 27-year-old man undergoing an induced-hypothermia protocol developed a fever about 4 days after receiving rocuronium infusions, with temperatures rising over 11 days to a maximum of 105.2 °F. In the other case, a 63-year-old man being treated for serious complications of elective surgery developed extreme fever (maximum temperature of 107.1 °F) about 4 days after receiving two bolus doses and a continuous infusion of rocuronium. In both cases, the discontinuation of rocuronium therapy was followed by the rapid diminution of fever over 12-36 hours. After consultations with medical staff and consideration of other potential causal and contributory factors (e.g., neurologic injury, antimicrobial-induced fever), rocuronium was deemed the most likely trigger of the severe febrile response experienced by these two patients.
A 27-year-old man and a 63-year-old man received rocuronium and subsequently developed delayed-onset malignant hyperthermia, which resolved after the rocuronium was discontinued.
报告两例疑似与非去极化神经肌肉阻滞剂使用相关的恶性高热病例。
恶性高热是一种可能在多达 1/3000 例麻醉过程中发生的遗传药理学疾病，与某些麻醉气体和去极化神经肌肉阻滞剂（如琥珀酰胆碱）的使用有关。尽管在少数已发表的报告中指出非去极化神经肌肉阻滞剂是导致恶性高热发展的原因之一，但这些药物通常被认为在有风险的患者中使用是安全的。研究人员报告了两例使用非去极化神经肌肉阻滞剂罗库溴铵的患者，他们被认为患有恶性高热，而这些患者没有已知的该疾病病史。在一个病例中，一名 27 岁的危重病患者在接受诱导性低温治疗方案后，在接受罗库溴铵输注约 4 天后出现发热，体温在 11 天内上升至最高 105.2°F。在另一个病例中，一名 63 岁的男子在接受择期手术严重并发症治疗时，在接受两次罗库溴铵推注和持续输注后约 4 天出现高热（最高体温为 107.1°F）。在这两种情况下，停止罗库溴铵治疗后，体温在 12-36 小时内迅速下降。在与医务人员进行咨询并考虑其他潜在的因果和促成因素（例如，神经损伤、抗菌药物引起的发热）后，罗库溴铵被认为是这两名患者经历严重发热反应的最可能原因。
一名 27 岁男性和一名 63 岁男性接受了罗库溴铵治疗，随后出现迟发性恶性高热，在停止使用罗库溴铵后，高热得到缓解。
