[Limited anesthetic possibilities in patients with hereditary muscular diseases]

An autopsy case of malignant hyperthermia

A report is made of a 44-year-old female who died of malignant hyperthermia during general anesthesia for an operation of left subtrochanteric femoral fracture. Symptoms began with increases in heart rate and blood pressure after the introduction of anesthesia with halothane and were accelerated by the administration of succinylcholine, followed by muscle rigidity and high temperature. The typical wine red urine was observed. The oral temperature of 42 degrees C was recorded within 1 h after succinylcholine. The rectal temperature was 30 degrees C 22 h after death. Severe pulmonary edema and tubular necrosis of the kidney were found by postmortem examination. No latent myopathy was observed. The creatine phosphokinase levels in plasma obtained after the onset of malignant hyperthermia and at the time of autopsy were abnormally high and were 5632 and 34,854 mU/ml, respectively. Plasma myoglobin levels were 130,000 and 2.8 X 10(6) ng/ml, respectively.

[Malignant hyperthermia following an old gunshot head injury]

A case of symptomatic malignant hyperthermia is reported involving a 35-year-old man who suffered a serious cerebral injury after a gunshot to the head and who died from hyperthermia (41.5 degrees C) and tachycardia 1.5 days after dental treatment under general anesthesia. The sceletal muscles did not show any changes that would indicate a myopathy, the CPL value was normal, there was also no familial factor in this case. It is taken as an opportunity here to point out that such a case must not end fatally since there is a drug on the market in the meantime (Dantrolen) which is to be administered i.v. This medication acts causally on the membrane disturbances (release of calcium ions by appropriate trigger substances) which are the underlying cause of the malignant hyperthermia.

Malignant hyperthermia

A report is made of a 65-year-old male who died of a malignant hyperthermia of 42 degrees C. Symptoms included muscle rigidity at the termination of operation for neck-clipping of an aneurysm of the anterior communicating artery. Latent myopathy was observed in skeletal muscle, and a bleeding focus was present in the left anterior region of the hypothalamus, coinciding with the temperature regulation center. The mechanism of onset of this disease is still poorly understood, but it seems that this disease occurred due to synergic effects of the hypothalamic hemorrhage and the pre-existing myopathy. The serum CPK level at the time of death was abnormally high (250 U), and 3.4% of isozyme CPK1 was detected. The serum myoglobin was 204, 850 ng/ml, a markedly high level, and myoglobinuric nephrosis was present as a result.