Allen G C, Cattran C B
Department of Anaesthesia, University of Ottawa, Ontario.
Can J Anaesth. 1989 Jan;36(1):81-5. doi: 10.1007/BF03010893.
A 55-year-old, malignant hyperthermia-susceptible patient underwent myocardial revascularization without incident. Six hours postoperatively, he developed what was initially diagnosed as an MH crisis, for which he received intravenous dantrolene. The resultant muscle weakness prolonged the duration of postoperative mechanical ventilation and likely contributed to the development of a postoperative pneumonia. Plasma dantrolene levels were measured for the first 48 hours postoperatively and correlated with clinical findings. On reviewing the patient's perioperative course, it was felt that the hypermetabolic state was not due to MH. The patient's pattern of rewarming following hypothermic cardiopulmonary bypass was similar to non-MH-susceptible patients. Because of the difficulty in diagnosing a MH crisis after hypothermic bypass, it is recommended that patients receive prophylactic dantrolene preoperatively and after bypass. Nondepolarizing muscle relaxants should be given postoperatively to prevent shivering and respiratory acidosis while patients rewarm.
一名55岁的恶性高热易感患者顺利接受了心肌血运重建术。术后6小时，他出现了最初被诊断为恶性高热危象的情况，为此接受了静脉注射丹曲林治疗。由此产生的肌肉无力延长了术后机械通气的时间，并可能导致了术后肺炎的发生。术后最初48小时测量了血浆丹曲林水平，并与临床发现进行了关联。回顾患者的围手术期过程，发现高代谢状态并非由恶性高热引起。该患者在低温体外循环后的复温模式与非恶性高热易感患者相似。由于低温体外循环后诊断恶性高热危象存在困难，建议患者在术前和体外循环后接受预防性丹曲林治疗。术后应给予非去极化肌松药，以防止患者复温时出现寒战和呼吸性酸中毒。
