Desflurane
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Malignant hyperthermia: case report A 14-year-old boy developed malignant hyperthermia following the administration of desflurane for general anaesthesia. The boy (weight 50kg) presented for elective plating of right radius and ulna. Before surgery his vital signs and laboratory tests were normal. Later, he received generals anaesthetics such as fentanyl, propofol and sevoflurane through mask ventilation with a mixture of oxygen FiO2 1.0. Thereafter, his general anaesthesia was maintained with 7% desflurane in a mixture of oxygen FiO2 0.5, to achieve minimal alveolar concentration (MAC) of 1.0. Then, he received morphine. The surgery was started as per usual. His heart rate ranged between 60 and 82 bpm, BP ranges between 95–122/63-90mm Hg and body temperature was 36.2-36.4°C. He gradually became tachycardic with a rise in heart rate (120 bpm), BP (130-150/70-85mm Hg) and body temperature (37.5°C). Initially, it was suspected to be an inadequate depth of anaesthesia, pain, early sepsis and bleeding. Therefore, he received morphine, paracetamol, and received desflurane again to achieve MAC 1.2. He also received Hartmann’s solution. However, his tachycardia continued to worsen with a rise in heart rate (160 bpm) the end-tidal carbon dioxide concentration (ETCO2) from 40mm Hg to 70mm Hg. His body temperature suddenly increased to 39.8°C, however, his muscle tone was not changed. These finding highly suggestive for malignant hyperthermia. Thereafter, surgery was stopped and suspected trigger agent desflurane was discontinued. Thereafter, the boy was put on an external oxygen supply. His anaesthesia was maintained with propofol and remifentanil. Active cooling was initiated with placing ice packs on the chest abdomen and bilateral axillae. Later, he received dantrolene, subsequently, arterial cannulation was performed to monitor his BP and arterial blood gases. Then, he was intubated with a size 7.5 cuffed endotracheal tube. His cardiac monitor signifying hyperkalemia. Therefore, he received calcium-gluconate along with glucose [dextrose]. After 20 to 30 min of dantrolene administration, his condition improved. Then, his surgery was continued and completed after 60 min of malignant hyperthermia episode. Following the surgery, his blood tests showed severe hyperkalemia with mild acute kidney injury (AKI) [aetiology not stated]. His hyperkalaemia resolved after receiving lytic cocktail. Lin HJ, et al. A rare occurrence of suspected delayed malignant hyperthermia in a young patient undergoing an orthopaedic surgery. Gazi Medical Journal 31: 677-679, No. 4, 803515709 Sep 2020. Available from: URL: http://doi.org/10.12996/GMJ.2020.157
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Reactions 21 Nov 2020 No. 1831
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