Abstract
A previously healthy 18-year-old male, following appendectomy developed post-anaesthetic hyperthermia (42.1° C) with an elevation of serum creatine kinase and activated partial thromboplaslin time. Repeated arterial blood gases were normal. Cooling and anti-pyretic medication did not control the fever. In contrast, sodium dantrolene appeared effective in lowering the patient’s temperature and normalizing the vital signs, both acutely and over the following three days. Subsequent muscle biopsy revealed a normal contracture response to caffeine alone or in the presence ofhalothane. However, the muscle had a larger than normal potentiation of evoked twitch tension in the presence of caffeine and halothane. Electrophoresis of the muscle revealed a marked increase of an unidentified low molecular weight protein. The patient’s clinical course, and the results of the muscle studies, sugest that an abnormality of skeletal muscle, other than that seen in the classic malignant hyperthermia syndrome may result in anaesthesia-related hyperthermia.
Résumé
Un jeune patient de dix-huit ans, auparavant en bonne santé, développa, après l’intervention chirurgicale de l’appendicite, une hyperthermie (42.1° C), ainsi qu’une hausse de sérum de créatine-kinase et un temps de céphaline-kaolin. Les résultats de l’analyse des gaz sanguins furent normaux à maintes reprises. Les médicaments anti-pyrétiques et le refroidissement de surface n’ont pas réussi à controler la fièvre. Par contre, le sodium dantrolène semble efficace pour diminuer la température du patient et pour normaliser les signes vitaux durant la période immédiate et pendant les trois jours suivants, Après une biopsie subséquente du muscle, on observa une réponse normale de contracture avec la caféine seulement ou avec la caféine en présence d’halotane. Cependant, on observa une augmentation plus grande que la normale de la secousse musculaire en présence de caféine et d’halotane. L’électrophorèse du muscle révèla une augmentation marquée d’ une protéine non identifiée de faible poids moléculaire. L’évolution du patient en clinique et les résultats des observations sur l’étude des muscles suggèrent qu’une abnormalité des muscles squelettiques, autre que celle observée dans les cas d’hyperthermie maligne peut mener à l’hyperthermie associée à l’anesthésie.
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The study was funded in part by the Benjamin J. Kripke, M.D. Inc. Research Fund, The Muscular Dystrophy Association, the National Institute of Health and the National Institute for General Medical Services.
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Kripke, B.J., Blanck, T.J.J., Sizemore, D.A. et al. Association of postanaesthetic hyperthermia with abnormal muscle characteristics: A case report. Can Anaesth Soc J 30, 290–294 (1983). https://doi.org/10.1007/BF03013810
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DOI: https://doi.org/10.1007/BF03013810