Engelsk titel: A 17-year-old woman with acute abdomen
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Författare:
Martin YK
;
Smith-Erichsen N
Email: yvonne.martin@ahus.no
Språk: Nor
Antal referenser: 10
Dokumenttyp:
Fallbeskrivning
UI-nummer: 09021932
Sammanfattning
A 17-year-old woman was admitted to hospital with acute appendicitis. Laparoscopic appendectomy was decided and anaesthesia induced with intravenous fentanyl (0.15 mg) and thiopental sodium (275 mg); succinylcholine (80 mg) was used for tracheal intubation. It was first impossible to open the patient’s mouth, but after an extra dose of 20 mg succinylcholine tracheal intubation could be initiated. Anaesthesia was maintained with sevoflurane and fentanyl, muscle relaxation with vecuronium. Endtidal CO2 (etCO2) was initially elevated and increased further to a maximum value of 9.1 volume % within 20 min, in spite of increased minute ventilation. Heart rate decreased after induction, but increased rapidly to 145 beats/min at maximum etCO2 level. Body temperature increased to 40.1 °C in parallel with etCO2.
Malignant hyperthermia was suspected and dantrolen 120 mg was given intravenously. Thereafter, symptoms rapidly declined. Surgery was terminated as soon as possible. Temperature increased again two hours later and a new dose of dantrolen was given. The patient was given six doses (850 mg dantrolen) over the following three days. Maximum creatine kinase value was 41219 U/L on the first postoperative day. She scored 68 points on the Malignant Hyperthermia Clinical Grading Score, which is well over the level (50) to confirm that she suffered an attack of malignant hyperthermia. She was discharged from ICU after three days and from hospital after 8 days without sequelae.