Desflurane
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Reactions 1476, p15 - 2 Nov 2013 S Desflurane Malignant hyperthermia in an elderly patient: case report A 66-year-old man developed malignant hyperthermia while receiving desflurane. The man had asymptomatic posterior mitral valve prolapse and underwent elective laparoscopic prostatectomy under general anaesthesia. He received midazolam prior to anaesthesia induction. General anaesthesia was induced with thiopental sodium, fentanyl and atracurium besilate, and was maintained with desflurane [dosage and route not stated], fentanyl and remifentanil. Ephedrine and atropine were administered, and he was positioned in a steep Trendelenburg position for surgery. He then underwent capnoperitoneum, and received clonidine. A forced warm air device was installed to maintain core temperature, which was 36.5°C at that time. Vital signs remained stable over the next 210 minutes. About 240 minutes after induction, he had a continuous increase in end-tidal CO2 from 4.5 kPa to 5.3 kPa, while core temperature rose from 37.1°C to 37.7°C. The forced warm air was stopped, and minute ventilation increased. In the following 90 minutes, his core temperature increased rapidly to 39.4°C, his end-tidal CO2 increased to 8.8 kPa and his HR increased from 80 beats/min to 130 beats/min. Blood tests 390 minutes after induction showed respiratory acidosis. Malignant hyperthermia was suspected. Desflurane was withdrawn, and anaesthesia was maintained with propofol. The man’s ventilator was changed, and he received dantrolene. He was uncovered, and cool wet blankets were applied. Within 30 minutes, his core temperature returned to 37.2°C, and his end-tidal CO2 decreased to 5.0 kPa. Surgery was terminated, and he was transferred to an ICU. His serum creatine kinase level peaked at 7133 IU/L. He was extubated, and later made a full recovery. Three months after discharge, he underwent testing for malignant hyperthermia susceptibility. In vitro contracture testing with halothane and caffeine was positive, and a molecular genetic analysis of the ryanodine receptor gene showed mutation c.7007G>A (p.Arg2336His). Author comment: "[W]e describe this case of a confirmed episode of malignant hyperthermia triggered by desflurane". Freiermuth D, et al. Difficult diagnosis of malignant hyperthermia during laparoscopic surgery. European Journal of Anaesthesiology 30: 635-638, No. 10, Oct 2013. Available from: URL: http://dx.doi.org/10.1097/EJA.0b013e328361d323 - Switzerland 803095079 1 Reactions 2 Nov 2013 No. 1476 0114-9954/13/1476-0001/$14.95 Adis © 2013 Springer International Publishing AG. All rights reserved
Transcript of Desflurane
Reactions 1476, p15 - 2 Nov 2013
SDesflurane
Malignant hyperthermia in an elderly patient: casereport
A 66-year-old man developed malignant hyperthermia whilereceiving desflurane.
The man had asymptomatic posterior mitral valve prolapseand underwent elective laparoscopic prostatectomy undergeneral anaesthesia. He received midazolam prior toanaesthesia induction. General anaesthesia was induced withthiopental sodium, fentanyl and atracurium besilate, and wasmaintained with desflurane [dosage and route not stated],fentanyl and remifentanil. Ephedrine and atropine wereadministered, and he was positioned in a steep Trendelenburgposition for surgery. He then underwent capnoperitoneum,and received clonidine. A forced warm air device was installedto maintain core temperature, which was 36.5°C at that time.Vital signs remained stable over the next 210 minutes. About240 minutes after induction, he had a continuous increase inend-tidal CO2 from 4.5 kPa to 5.3 kPa, while core temperaturerose from 37.1°C to 37.7°C. The forced warm air was stopped,and minute ventilation increased. In the following 90 minutes,his core temperature increased rapidly to 39.4°C, his end-tidalCO2 increased to 8.8 kPa and his HR increased from80 beats/min to 130 beats/min. Blood tests 390 minutes afterinduction showed respiratory acidosis. Malignanthyperthermia was suspected.
Desflurane was withdrawn, and anaesthesia was maintainedwith propofol. The man’s ventilator was changed, and hereceived dantrolene. He was uncovered, and cool wet blanketswere applied. Within 30 minutes, his core temperaturereturned to 37.2°C, and his end-tidal CO2 decreased to5.0 kPa. Surgery was terminated, and he was transferred to anICU. His serum creatine kinase level peaked at 7133 IU/L. Hewas extubated, and later made a full recovery. Three monthsafter discharge, he underwent testing for malignanthyperthermia susceptibility. In vitro contracture testing withhalothane and caffeine was positive, and a molecular geneticanalysis of the ryanodine receptor gene showed mutationc.7007G>A (p.Arg2336His).
Author comment: "[W]e describe this case of a confirmedepisode of malignant hyperthermia triggered by desflurane".Freiermuth D, et al. Difficult diagnosis of malignant hyperthermia duringlaparoscopic surgery. European Journal of Anaesthesiology 30: 635-638, No. 10,Oct 2013. Available from: URL: http://dx.doi.org/10.1097/EJA.0b013e328361d323- Switzerland 803095079
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Reactions 2 Nov 2013 No. 14760114-9954/13/1476-0001/$14.95 Adis © 2013 Springer International Publishing AG. All rights reserved
