Sold M, Tschöp M, Sörensen N
Anaesthesist. 1986 Oct;35(10):634-8.
We report the case of a 4.9-year-old boy with congenital hydrocephalus and obstruction of his shunt who just after the induction of anaesthesia suddenly developed generalized muscle rigidity that made intubation impossible. Because of temporary mydriasis the situation could hardly be differentiated from acute cerebral herniation. The lack of any decrease in muscle tone after emergency trephination and drainage of the right lateral ventricle and the immediate improvement following intravenous dantrolene left no doubt about the diagnosis of malignant hyperthermia. The diagnosis was confirmed by the increase in serum creatine phosphokinase and the documentation of massive myoglobinuria. Reconstruction of the course of the first anaesthetic necessary for shunt implantation at the age of 62 days revealed that the same symptoms already had occurred. However, they then were not attributed to malignant hyperthermia but interpreted as symptoms of acute herniation. A detailed description of this first anaesthetic is given which again elucidates the problems associated with the abrupt onset of muscular hypertonus in a patient with neurologic disorder; moreover this may well be the first published case report of malignant hyperthermia at the age of just 2 months.
我们报告了一例4.9岁患有先天性脑积水且分流管梗阻的男孩，其在麻醉诱导后突然出现全身肌肉强直，导致无法进行插管。由于出现暂时性瞳孔散大，这种情况很难与急性脑疝相鉴别。在紧急行右侧脑室钻孔引流后肌张力未出现任何降低，而静脉注射丹曲林后症状立即改善，这使得恶性高热的诊断确凿无疑。血清肌酸磷酸激酶升高及大量肌红蛋白尿的记录证实了该诊断。回顾62天龄时进行分流管植入首次麻醉的过程发现，相同症状此前已经出现。然而，当时这些症状未被归因于恶性高热，而是被解释为急性脑疝的症状。本文给出了对首次麻醉的详细描述，再次阐明了神经系统疾病患者突然出现肌肉张力亢进所带来的问题；此外，这很可能是首例仅2个月大婴儿发生恶性高热的病例报告。
