Houvenaeghel M, Achilli-Cornesse E, Jullian-Papouin H, Martin-Meyssonier A, Manelli J C
Département d'Anesthésie-Réanimation, Hôpital de la Conception, Marseille.
Ann Fr Anesth Reanim. 1988;7(5):408-11. doi: 10.1016/s0750-7658(88)80058-3.
A 33 year old woman, with myotonia atrophica and a known susceptibility to malignant hyperthermia, presented during her second pregnancy with multiple episodes of hyperthermia. They were associated with a rapid rise in the serum creatine phosphokinase (CPK) level, and not with infection or a myotonic crisis. Because of the obstetric conditions, caesarean section was planned. Preoperative oral dantrolene was used as prophylaxis. Six days after the start of this treatment, CPK and serum myoglobin levels were back within the normal range. There were no side-effects for the mother nor for the foetus. There were no further increases in either CPK or serum myoglobin levels during surgery or afterwards, but the rectal temperature remained markedly raised for 48 h after the delivery. Oral dantrolene was given during the first nine postoperative days. The occurrence of episodes of high fever during pregnancy linked to MHS and myotonia atrophica is discussed, as well as the anaesthetic management of such a patient. Side-effects of dantrolene for the mother or the foetus are also considered, especially as foetal levels of this drug would seem not to reach therapeutic levels. It would appear interesting to measure maternal dantrolene blood levels, especially if high doses are administered, to avoid reaching therapeutic levels in the foetus.
一名33岁患有萎缩性肌强直且已知易患恶性高热的女性，在其第二次怀孕期间出现多次体温过高情况。这些情况与血清肌酸磷酸激酶（CPK）水平迅速升高有关，与感染或肌强直危象无关。由于产科情况，计划进行剖宫产。术前口服丹曲林用作预防措施。开始这种治疗六天后，CPK和血清肌红蛋白水平恢复到正常范围。对母亲和胎儿均无副作用。手术期间及术后，CPK或血清肌红蛋白水平均未进一步升高，但产后直肠温度在48小时内仍显著升高。术后头九天给予口服丹曲林。讨论了与恶性高热综合征和萎缩性肌强直相关的孕期高热发作情况，以及此类患者的麻醉管理。还考虑了丹曲林对母亲或胎儿的副作用，特别是因为该药物在胎儿体内的水平似乎未达到治疗水平。测量母亲的丹曲林血药浓度似乎很有意思，尤其是在给予高剂量药物时，以避免胎儿体内达到治疗水平。
