[Lack of sensitivity to per-anesthetic malignant hyperthermia in 32 patients who developed neuroleptic malignant syndrome]

[Malignant hyperthermia susceptibility in 3 patients with malignant neuroleptic syndrome]

Hyperthermia, skeletal muscle rigidity, rhabdomyolysis, acidosis and multiple system insufficiency characterize malignant hyperthermia. Anaesthetic malignant hyperthermia follows halogenated volatile agents and/or depolarizing muscle relaxants utilization. Diagnosis is based on in vitro muscle contracture in response to halothane and/or caffeine exposure. Neuroleptic malignant syndrome affects patients taking neuroleptic drugs; clinical findings include hyperthermia, extrapyramidal rigidity, acidosis, neurovegetative instability and neurological signs. We report three neuroleptic malignant syndrome patients with positive muscle contracture tests which shows that muscle from neuroleptic malignant syndrome patients may in some instances show alterations similar to those of anaesthetic malignant hyperthermia.

[Malignant hyperthermia and appendicular sepsis. Can they be differentiated during surgical procedure?]

OBJECTIVE

To assess the possibility to differentiate clinically intraoperative malignant hyperthermia (MH) and sepsis.

STUDY DESIGN

Comparative retrospective study of clinical cases.

PATIENTS

Sixteen patients operated on for acute appendicitis and developing clinical signs of MH confirmed or not by in vitro caffeine halothane contracture tests (IVCT).

METHOD

To isolate the patients' characteristics with regard to the diagnosis of sepsis and MH crisis. To compare both groups of clinical features with results of IVCT.

RESULTS

The diagnosis of MH sensitivity has been excluded in ten hyperthermic patients and confirmed in four others with IVCT. No correlation was existing between the importance of perioperative sepsis, MH features and IVTC results.

CONCLUSIONS

This study confirmed the difficulty to differentiate clinically MH and sepsis during surgery. Considering the severe outcome of MH crisis, it is recommended to start the specific therapy even in case of appendicular sepsis.

[Severe hyperthermia caused by sudden withdrawal of continuous intrathecal administration of baclofen]

Baclofen is used for the treatment of post-traumatic spasticity. It carries a risk of overdose as well as of an acute withdrawal syndrome. We report two cases of severe hypertonia and hyperthermia (> 42 degrees C), occurring after accidental discontinuation of intrathecal infusion of baclofen. Both hypertonia and hyperthermia ceased when administration of baclofen was resumed. In parallel, the patients developed transient life-threatening alterations of hepatic (cytolysis), haematologic (coagulopathy) and cardiorespiratory functions for some days. It is concluded that the occurrence of such a withdrawal syndrome should be prevented, especially in patients with chronic intrathecal administration and first symptoms should be recognized without delay. Relationships with other malignant hyperthermias are discussed.