Palmo Anest

Anaesthetic nightmare - Malignant Hyperthermia

We have a case of Malignant Hyperthermia last week. A 66 y.o. male came for elective thyroidectomy for his papillary carsinoma. Preoperatively he is euthyroid clinically and biochemically. No obstructive symptoms but imaging shows some invation to the trachea.

In view of possible difficult airway, my colleague induce him with IV Fentanyl, IV Thiopentone and IV Succinylcholine. Anaesthesia was maintain with Isoflurane and Tracium.

About 3 hr after induction, noted patient's ETCO2 going higher and higher. Did every thing usually done to correct hypercapnia but still persist. Then noted the whole body muscle regidity and petient was 42 degree C. IV Dantrolene Sodium started, and cooling down body with ais and cold saline infusion and lavarge done. By the time patient transfered to ICU, he is less regid and 36 degree C. He was put on ventilator support and needed 4 types of inotropes. Sedated with midazolam and pethidine. IV dantrolene continue with 1mg/hr.

On day 5 post op, patient developed Acute Renal Failure (late complication) Urea 20 and Creatinine 330. Urine output was about 10-20/hr for 3 hr inspite of CVP 26 and IV Frusemide 20+20mg given. BP adequate (SBP >120) with maximum inotropes (Dobu/Dopa/Adrenaline/NorAd at 20/20/20/20). Urine comming out adequately after starting of Lasix infusion.

He further complicated with ARDS on ARDS ventilator setting strategies.

Currently he is still holding on with lower ventilator setting and also lower inotropes support.

I'm on-call tomorrow and will see how he is doing. Hopefully he can make it.

posted by LT @ 3:12 PM