Department of Anesthesia, Tokyo Medical University, 6-7-1 Nishi-shinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
Department of Plastic Surgery, Tokyo Medical University, 6-7-1 Nishi-shinjuku, Shinjuku-ku, Tokyo, Japan.
J Med Case Rep. 2021 Apr 17;15(1):201. doi: 10.1186/s13256-021-02681-0.
Malignant hyperthermia (MH) is a rare genetic disease characterized by the development of very serious symptoms, and hence prompt and appropriate treatment is required. However, postoperative MH is very rare, representing only 1.9% of cases as reported in the North American Malignant Hyperthermia Registry (NAMHR). We report a rare case of a patient who developed sudden postoperative hyperthermia after mastectomy, which was definitively diagnosed as MH by the calcium-induced calcium release rate (CICR) measurement test.
A 61-year-old Japanese woman with a history of stroke was hospitalized for breast cancer surgery. General anesthesia was introduced by propofol, remifentanil, and rocuronium. After intubation, anesthesia was maintained using propofol and remifentanil, and mastectomy and muscle flap reconstruction surgery was performed and completed without any major problems. After confirming her spontaneous breathing, sugammadex was administered and she was extubated. Thereafter, systemic shivering and masseter spasm appeared, and a rapid increase in body temperature (maximum: 38.9 °C) and end-tidal carbon dioxide (ETCO) (maximum: 59 mmHg) was noted. We suspected MH and started cooling the body surface of the axilla, cervix, and body trunk, and administered chilled potassium-free fluid and dantrolene. After her body temperature dropped and her shivering improved, dantrolene administration was ended, and finally she was taken to the intensive care unit (ICU). Body cooling was continued within the target range of 36-37 °C in the ICU. No consciousness disorder, hypotension, increased serum potassium level, metabolic acidosis, or cola-colored urine was observed during her ICU stay. Subsequently, her general condition improved and she was discharged on day 12. Muscle biopsy after discharge was performed and provided a definitive diagnosis of MH.
The occurrence of MH can be life-threatening, but its frequency is very low, and genetic testing and muscle biopsy are required to confirm the diagnosis. On retrospective evaluation using the malignant hyperthermia scale, the present case was almost certainly that of a patient with MH. Prompt recognition and immediate treatment with dantrolene administration and body cooling effectively reversed a potentially fatal syndrome. This was hence a valuable case of a patient with postoperative MH that led to a confirmed diagnosis by CICR.
恶性高热（MH）是一种罕见的遗传性疾病，其特征为严重症状的发展，因此需要及时、恰当的治疗。然而，术后 MH 非常罕见，北美恶性高热登记处（NAMHR）报告的病例仅占 1.9%。我们报告了一例罕见的患者，该患者在乳房切除术后出现突发性术后高热，通过钙诱导钙释放率（CICR）测量试验明确诊断为 MH。
一位 61 岁的日本女性，有中风病史，因乳腺癌手术住院。全身麻醉采用异丙酚、瑞芬太尼和罗库溴铵诱导。插管后，采用异丙酚和瑞芬太尼维持麻醉，并完成了乳房切除术和肌肉皮瓣重建手术，过程中无重大问题。在确认其自主呼吸后，给予舒更葡糖，并将其拔出。此后，出现全身颤抖和咀嚼肌痉挛，体温（最高：38.9°C）和呼气末二氧化碳（ETCO）（最高：59mmHg）迅速升高。我们怀疑是 MH，开始对腋窝、颈部和躯干的体表进行冷却，并给予冷钾无氟液和丹曲林钠。体温下降，颤抖缓解后，停止使用丹曲林钠，最终将其转入重症监护病房（ICU）。在 ICU 期间，继续将体温控制在 36-37°C 的目标范围内。在 ICU 住院期间，未观察到意识障碍、低血压、血清钾水平升高、代谢性酸中毒或可乐色尿。随后，患者一般情况改善，于第 12 天出院。出院后进行了肌肉活检，明确诊断为 MH。
MH 的发生可能危及生命，但频率非常低，需要进行基因检测和肌肉活检以确认诊断。回顾性使用恶性高热量表评估，本例几乎肯定是 MH 患者。及时识别并立即使用丹曲林钠和体表降温治疗，有效地逆转了潜在致命的综合征。这是一例非常有价值的术后 MH 病例，通过 CICR 确诊。
