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Zheng Q, Liu N, Zeng Y, Chen Y, Zhang H, Su X, Zhuang J. Successful Treatment Without Using Dantrolene Sodium on a Child Occurring Malignant Hyperthermia During Induction of General Anesthesia: A Case Report. J Craniofac Surg 2024; 35:e351-e354. [PMID: 38829149 DOI: 10.1097/scs.0000000000010077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 01/15/2024] [Indexed: 06/05/2024] Open
Abstract
Malignant hyperthermia (MH) is a fatal hyperthermia with a high mortality, which usually occurs during induction of general anesthesia. Dantrolene sodium is a wonder drug currently used for treating malignant hyperthermia. However, preparing, storing, and maintaining dantrolene sodium are crucially expensive, thus making it financially unsatisfactory and difficult for clinicians to acquire in time. Monitoring patients' condition closely and intervening promptly when early signs of malignant hyperthermia occur can effectively prevent the condition from worsening and win over time for the arrival of dantraline sodium. This article is to report a case in which we successfully rescued a child occurring malignant hyperthermia without using dantrolene sodium.
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Affiliation(s)
- Qiaoyuan Zheng
- College of Clinical Medicine, Fudan University, Shanghai
| | - Na Liu
- School of Nursing, Peking Union Medical College
| | | | | | | | - Xueshang Su
- Department of Cicatrix Minimally Invasive Treatment Center
| | - Jun Zhuang
- Department of Ear Reconstruction, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College. Beijing, People's Republic of China
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Hepps Keeney CM, Gorges MA, Gremling MM, Chinnadurai SK, Harrison TM. HYPERKALEMIA IN FOUR ANESTHETIZED RED WOLVES ( CANIS RUFUS). J Zoo Wildl Med 2023; 54:387-393. [PMID: 37428704 DOI: 10.1638/2022-0100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2023] [Indexed: 07/12/2023] Open
Abstract
Four clinically healthy red wolves (Canis rufus) developed hyperkalemia during routine anesthetic procedures. All cases were anesthetized using a combination of dexmedetomidine (10-24 mcg/kg), ketamine (2-3 mg/kg), and either midazolam (0.25-0.5 mg/kg) or butorphanol (0.2-0.48 mg/kg). Additional anesthetics were given to effect. Total anesthetic time ranged from 60 to 420 min. Three out of four cases were treated using terbutaline (0.01 mg/kg SC), which successfully resolved the hyperkalemia. No bradyarrhythmias were seen in any cases where electrocardiography (ECG) was monitored (3/4). All cases recovered from anesthesia, with one prolonged recovery. All animals are clinically healthy at the time of writing. Factors including anesthetic duration, the use of α-2 agonists, hyperthermia, and genetics are discussed as possible triggers for hyperkalemia. Serial blood gases, with electrolyte measurements, are recommended during anesthesia of red wolves, particularly when anesthetic time may be prolonged or the patient suffers from hyperthermia. Terbutaline appears to be a successful treatment should hyperkalemia arise.
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Affiliation(s)
- Caitlin M Hepps Keeney
- Department of Clinical Sciences, North Carolina State University College of Veterinary Medicine, Raleigh, NC 27607, USA
| | - Melinda A Gorges
- Department of Clinical Sciences, North Carolina State University College of Veterinary Medicine, Raleigh, NC 27607, USA
| | - Megan M Gremling
- Department of Clinical Sciences, North Carolina State University College of Veterinary Medicine, Raleigh, NC 27607, USA
| | | | - Tara M Harrison
- Department of Clinical Sciences, North Carolina State University College of Veterinary Medicine, Raleigh, NC 27607, USA,
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Identification of Potential Biomarkers for Ryanodine Receptor 1 (RYR1) Mutation-Associated Myopathies Using Bioinformatics Approach. DISEASE MARKERS 2022; 2022:8787782. [PMID: 35692882 PMCID: PMC9187445 DOI: 10.1155/2022/8787782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 04/28/2022] [Indexed: 11/30/2022]
Abstract
Background Myopathies related to Ryanodine receptor 1 (RYR1) mutation are the most common nondystrophy muscle disorder in humans. Early detection and diagnosis of RYR1 mutation-associated myopathies may lead to more timely treatment of patients, which contributes to the management and preparation for malignant hyperthermia. However, diagnosis of RYR1 mutation-associated myopathies is delayed and challenging. The absence of diagnostic morphological features in muscle biopsy does not rule out the possibility of pathogenic variations in RYR1. Accordingly, it is helpful to seek biomarkers to diagnose RYR1 mutation-associated myopathies. Methods Skeletal muscle tissue microarray datasets of RYR1 mutation-associated myopathies or healthy persons were built in accordance with the gene expression synthesis (GEO) database. Differentially expressed genes (DEGs) were identified on the basis of R software. Genes specific to tissue/organ were identified through BioGPS. An enrichment analysis of DEGs was conducted in accordance with the Kyoto Encyclopedia of Genes and Genomes (KEGG) and Gene Ontology (GO). We also built protein-protein interaction (PPI) networks to explore the function and enrichment pathway of DEGs and the identification of hub genes. Lastly, the ROC curve was drawn for hub genes achieving specific expressions within skeletal muscle. Moreover, the area under the curve (AUC) was obtained to calculate the predictive value of key genes. The transcription factors of hub genes achieving specific expressions within skeletal muscle were predicted with the use of the iRegulon plugin. Results We identified 170 DEGs among 11 muscle biopsy samples of healthy subjects and 17 muscle biopsy samples of RYR1 mutation-associated myopathy patients in the dataset. Among the above DEGs, 30 genes achieving specific expressions within tissues/organs were found. GO and KEGG enrichment analysis of DEGs mainly focused on muscle contraction, actin-mediated cell contraction, actin filament-based movement, and muscular sliding. 12 hub genes were identified with the use of Cytoscape. Four hub genes were specifically expressed in skeletal muscle tissue, including MYH1 (AUC: 0.856), TNNT3 (AUC: 0.840), MYLPF (AUC: 0.786), and ATP2A1 (AUC: 0.765). The iRegulon predicted results suggested that the transcription factor MYF6 was found with the highest reliability. Conclusions Four skeletal muscle tissue-specific genes were identified, including MYH1, TNNT3, MYLPF, and ATP2A1, as the potential biomarkers for diagnosing and treating RYR1 mutation-associated myopathies, which provided insights into the transcriptome-level development mechanism. The transcription factor MYF6 may be a vital upstream regulator of the above biomarkers.
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Micaglio E, Locati ET, Monasky MM, Romani F, Heilbron F, Pappone C. Role of Pharmacogenetics in Adverse Drug Reactions: An Update towards Personalized Medicine. Front Pharmacol 2021; 12:651720. [PMID: 33995067 PMCID: PMC8120428 DOI: 10.3389/fphar.2021.651720] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 03/29/2021] [Indexed: 12/28/2022] Open
Abstract
Adverse drug reactions (ADRs) are an important and frequent cause of morbidity and mortality. ADR can be related to a variety of drugs, including anticonvulsants, anaesthetics, antibiotics, antiretroviral, anticancer, and antiarrhythmics, and can involve every organ or apparatus. The causes of ADRs are still poorly understood due to their clinical heterogeneity and complexity. In this scenario, genetic predisposition toward ADRs is an emerging issue, not only in anticancer chemotherapy, but also in many other fields of medicine, including hemolytic anemia due to glucose-6-phosphate dehydrogenase (G6PD) deficiency, aplastic anemia, porphyria, malignant hyperthermia, epidermal tissue necrosis (Lyell's Syndrome and Stevens-Johnson Syndrome), epilepsy, thyroid diseases, diabetes, Long QT and Brugada Syndromes. The role of genetic mutations in the ADRs pathogenesis has been shown either for dose-dependent or for dose-independent reactions. In this review, we present an update of the genetic background of ADRs, with phenotypic manifestations involving blood, muscles, heart, thyroid, liver, and skin disorders. This review aims to illustrate the growing usefulness of genetics both to prevent ADRs and to optimize the safe therapeutic use of many common drugs. In this prospective, ADRs could become an untoward "stress test," leading to new diagnosis of genetic-determined diseases. Thus, the wider use of pharmacogenetic testing in the work-up of ADRs will lead to new clinical diagnosis of previously unsuspected diseases and to improved safety and efficacy of therapies. Improving the genotype-phenotype correlation through new lab techniques and implementation of artificial intelligence in the future may lead to personalized medicine, able to predict ADR and consequently to choose the appropriate compound and dosage for each patient.
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Affiliation(s)
- Emanuele Micaglio
- Arrhythmology and Electrophysiology Department, IRCCS Policlinico San Donato, Milan, Italy
| | - Emanuela T Locati
- Arrhythmology and Electrophysiology Department, IRCCS Policlinico San Donato, Milan, Italy
| | - Michelle M Monasky
- Arrhythmology and Electrophysiology Department, IRCCS Policlinico San Donato, Milan, Italy
| | - Federico Romani
- Arrhythmology and Electrophysiology Department, IRCCS Policlinico San Donato, Milan, Italy.,Vita-Salute San Raffaele University, (Vita-Salute University) for Federico Romani, Milan, Italy
| | | | - Carlo Pappone
- Arrhythmology and Electrophysiology Department, IRCCS Policlinico San Donato, Milan, Italy.,Vita-Salute San Raffaele University, (Vita-Salute University) for Federico Romani, Milan, Italy
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5
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Gong X. Malignant hyperthermia when dantrolene is not readily available. BMC Anesthesiol 2021; 21:119. [PMID: 33863282 PMCID: PMC8051048 DOI: 10.1186/s12871-021-01328-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 03/30/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Malignant hyperthermia is a rare but life-threatening pharmacogenetic muscle disorder characterized by abnormal hypermetabolic reactions and commonly triggered in susceptible individuals by volatile anesthetics or succinylcholine, or both. Unfortunately, the specific medicine dantrolene is not readily available in many countries including China. The aim of this study was to find the characteristics of malignant hyperthermia under the situation that dantrolene is not readily available. METHODS The cases of malignant hyperthermia reported on the most commonly used databases in China from 1985 to 2020 were analyzed. The inclusion criteria were the MH episodes only related to anesthesia. The exclusion criteria were dubious MH episodes only caused by Ketamine administration or MH episodes irrelevant to anesthesia. Independent samples t-test and Pearson's chi-squared test were applied to assess the difference between the survived and death cases. RESULTS Ninety-two cases of malignant hyperthermia reported on the most commonly used databases in China from 1985 to 2020 were analyzed. Median (IQR [range]) age was 18.5 (11.8-37.0 [0-70.0]) years. Compared with the survived cases, the death cases had higher maximum end-tidal partial pressure of CO2 (P = 0.033), the maximum arterial partial pressure of CO2 (P = 0.006), temperature first measured when the patient was first discovered abnormal (P = 0.012), and maximum temperature (P < 0.001). Besides, the death cases had less minimum pH (P < 0.001) and higher potassium (P < 0.001) and were more likely to have coagulation disorders (p = 0.018). Concerning treatment, cases used furosemide (P = 0.024), mannitol (P = 0.029), blood purification treatment (P = 0.017) had the advantage on the outcome. Creatine phosphokinase, myoglobin, and MB isoenzyme of creatine phosphokinase differed greatly among cases during the first week. 43 (46.7%) cases had congenital diseases. 12 (13.0%) cases were reported with abnormal laboratory test results or abnormal signs that are possibly relevant before anesthesia. CONCLUSIONS In countries that dantrolene is not readily available, early warning, diagnosis, and prompt effective therapies are crucial for MH patients to survive.
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Affiliation(s)
- Xiaodan Gong
- Department of Cardiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité University Medicine, Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.
- Department of Anesthesiology, The Second Clinical Medical College, Yangtze University, Jingzhou, 434020, China.
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Thermogenic adipocytes: lineage, function and therapeutic potential. Biochem J 2020; 477:2071-2093. [PMID: 32539124 PMCID: PMC7293110 DOI: 10.1042/bcj20200298] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/13/2020] [Accepted: 05/15/2020] [Indexed: 12/12/2022]
Abstract
Metabolic inflexibility, defined as the inability to respond or adapt to metabolic demand, is now recognised as a driving factor behind many pathologies associated with obesity and the metabolic syndrome. Adipose tissue plays a pivotal role in the ability of an organism to sense, adapt to and counteract environmental changes. It provides a buffer in times of nutrient excess, a fuel reserve during starvation and the ability to resist cold-stress through non-shivering thermogenesis. Recent advances in single-cell RNA sequencing combined with lineage tracing, transcriptomic and proteomic analyses have identified novel adipocyte progenitors that give rise to specialised adipocytes with diverse functions, some of which have the potential to be exploited therapeutically. This review will highlight the common and distinct functions of well-known adipocyte populations with respect to their lineage and plasticity, as well as introducing the most recent members of the adipocyte family and their roles in whole organism energy homeostasis. Finally, this article will outline some of the more preliminary findings from large data sets generated by single-cell transcriptomics of mouse and human adipose tissue and their implications for the field, both for discovery and for therapy.
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Ndikontar R, Etoundi PO, Tochie JN, Bengono RSB, Minkande JZ. Malignant hyperthermia, a rare perioperative complication: case series and literature review. Oxf Med Case Reports 2020; 2020:omaa101. [PMID: 33343909 PMCID: PMC7733524 DOI: 10.1093/omcr/omaa101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/08/2020] [Accepted: 09/13/2020] [Indexed: 12/02/2022] Open
Abstract
Malignant hyperthermia is a rare complication of general anesthesia appearing as an acute and potentially lethal hypermetabolic state in people carrying a genetic anomaly expressed in skeletal muscles. Malignant hyperthermia has been scarcely described in sub-Saharan Africa. Herein, we present three cases of malignant hyperthermia occurring in the perioperative period in Cameroon. The authors wish to draw attention to the clinical presentation of this rare but potentially lethal emergency, for timely diagnosis, management and follow-up geared at preventing perioperative mortality.
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Affiliation(s)
- Raymond Ndikontar
- Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon.,Department of Anesthesiology and Critical Care Medicine, Yaoundé Gynaeco-Obstetric and Pediatric Hospital, Yaoundé, Cameroon
| | - Paul Owono Etoundi
- Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon.,Department of Emergency Medicine, Anesthesiology and Critical Care, Yaoundé Central Hospital, Yaoundé, Cameroon
| | - Joel Nouktadie Tochie
- Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon.,Department of Anesthesiology and Critical Care Medicine, Yaoundé Gynaeco-Obstetric and Pediatric Hospital, Yaoundé, Cameroon
| | - Roddy Stephan Bengono Bengono
- Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - Jacqueline Ze Minkande
- Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon.,Department of Anesthesiology and Critical Care Medicine, Yaoundé Gynaeco-Obstetric and Pediatric Hospital, Yaoundé, Cameroon
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8
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Packiasabapathy S, Rangasamy V, Horn N, Hendrickson M, Renschler J, Sadhasivam S. Personalized pediatric anesthesia and pain management: problem-based review. Pharmacogenomics 2020; 21:55-73. [PMID: 31849281 DOI: 10.2217/pgs-2019-0108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Pharmacogenetics, the genetic influence on the interpersonal variability in drug response, has enabled tailored pharmacotherapy and emerging 'personalized medicine.' Although oncology spearheaded the clinical implementation of personalized medicine, other specialties are rapidly catching up. In anesthesia, classical examples of genetically mediated idiosyncratic reactions have been long known (e.g., malignant hyperthermia and prolonged apnea after succinylcholine). The last two decades have witnessed an expanding body of pharmacogenetic evidence in anesthesia. This review highlights some of the prominent pharmacogenetic associations studied in anesthesia and pain management, with special focus on pediatric anesthesia.
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Affiliation(s)
- Senthil Packiasabapathy
- Department of Anesthesia, Indiana University School of Medicine, Riley Hospital for Children at Indiana University Health, Indianapolis, IN 46202, USA
| | - Valluvan Rangasamy
- Department of Anesthesia, Indiana University School of Medicine, Riley Hospital for Children at Indiana University Health, Indianapolis, IN 46202, USA
| | - Nicole Horn
- Department of Anesthesia, Indiana University School of Medicine, Riley Hospital for Children at Indiana University Health, Indianapolis, IN 46202, USA
| | - Michele Hendrickson
- Department of Anesthesia, Indiana University School of Medicine, Riley Hospital for Children at Indiana University Health, Indianapolis, IN 46202, USA
| | - Janelle Renschler
- Department of Anesthesia, Indiana University School of Medicine, Riley Hospital for Children at Indiana University Health, Indianapolis, IN 46202, USA
| | - Senthilkumar Sadhasivam
- Department of Anesthesia, Indiana University School of Medicine, Riley Hospital for Children at Indiana University Health, Indianapolis, IN 46202, USA
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Affiliation(s)
- Abhijit S Nair
- Department of Anaesthesiology, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
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10
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Feng QW, Cui ZG, Jin YJ, Sun L, Li ML, Zakki SA, Zhou DJ, Inadera H. Protective effect of dihydromyricetin on hyperthermia-induced apoptosis in human myelomonocytic lymphoma cells. Apoptosis 2020; 24:290-300. [PMID: 30684145 DOI: 10.1007/s10495-019-01518-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Dihydromyricetin (DMY) is a traditional herbal medicine, with a wide range of biological activities. Extreme hyperthermia (HT) can suppress the immune system; thus, protection of the immune system is beneficial in heat-related diseases, including heatstroke. In our study, we revealed the protective effect of DMY against HT-induced apoptosis and analysed the underlying molecular mechanisms. We incubated human myelomonocytic lymphoma U937 cells at 44 °C for 30 min with or without DMY and followed by further incubation for 6 h at 37 °C. Cell viability was determined by the CCK-8 assay. DMY did not cause any cytotoxic effects in U937 cells even at high doses. HT treatment alone induced significant apoptosis, which was detected by DNA fragmentation and Annexin V/PI double staining. Mitochondrial dysfunction was identified by loss of mitochondrial membrane potential (MMP) during heat stimulation. Apoptotic related proteins were involved, truncated Bid and caspase-3 were upregulated, and Mcl-1 and XIAP were downregulated. We also identified the related signalling pathways, such as the MAPK and PI3K/AKT pathways. However, changes in HT were dramatically reversed when the cells were pretreated with DMY before exposure to HT. Overall, MAPKs and PI3K/AKT signalling, mitochondrial dysfunction, and caspase-mediated pathways were involved in the protective effect of DMY against HT-induced apoptosis in U937 cells, which was totally reversed by DMY pretreatment. These findings indicate a new clinical therapeutic strategy for the protection of immune cells during heatstroke.
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Affiliation(s)
- Qian-Wen Feng
- Department of Public Health, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Zheng-Guo Cui
- Department of Public Health, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan.,Graduate School of Medicine, Henan Polytechnic University, Jiaozuo, 454000, China
| | - Yu-Jie Jin
- Department of Public Health, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Lu Sun
- Department of Public Health, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Meng-Ling Li
- Department of Public Health, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Shahbaz Ahmad Zakki
- Department of Public Health, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - De-Jun Zhou
- Graduate School of Medicine, Henan Polytechnic University, Jiaozuo, 454000, China
| | - Hidekuni Inadera
- Department of Public Health, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan.
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Almeida CGD, Colleti Junior J. MALIGNANT HYPERTHERMIA IN A CHILD AFTER MAGNETIC RESONANCE IMAGING: A CASE REPORT. ACTA ACUST UNITED AC 2020; 38:e2018267. [PMID: 32074225 PMCID: PMC7025443 DOI: 10.1590/1984-0462/2020/38/2018267] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 11/09/2018] [Indexed: 11/24/2022]
Abstract
Objective: To report on a case of malignant hyperthermia in a child after a magnetic
resonance imaging of the skull was performed using sevoflurane
anesthesia. Case description: A 3-year-old boy admitted to the pediatric intensive care unit after
presenting clinical and laboratory findings consistent with unspecified
viral meningoencephalitis. While the patient was sedated, a magnetic
resonance imaging of the skul was performed using propofol followed by the
administration of sevoflurane through a laryngeal mask in order to continue
anesthesia. Approximately three hours after the start of the procedure, the
patient presented persistent tachycardia, tachypnea, generalized muscular
stiffness and hyperthermia. With a diagnostic hypothesis of malignant
hyperthermia, dantrolene was then administered, which immediately induced
muscle stiffness, tachycardia, tachypnea and reduced body temperature. Comments: Malignant hyperthermia is a rare pharmacogenetic syndrome characterized by a
severe hypermetabolic reaction after the administration of halogenated
inhalational anesthetics or depolarizing muscle relaxants such as
succinylcholine, or both. Although it is a potentially fatal disease, the
rapid administration of continued doses dantrolene has drastically reduced
the morbidity and mortality of the disease.
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12
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Crosstalk between Calcium and ROS in Pathophysiological Conditions. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2019; 2019:9324018. [PMID: 31178978 PMCID: PMC6507098 DOI: 10.1155/2019/9324018] [Citation(s) in RCA: 111] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 04/01/2019] [Indexed: 12/12/2022]
Abstract
Calcium ions are highly versatile intracellular signals that regulate many cellular processes. The key to achieving this pleiotropic role is the spatiotemporal control of calcium concentration evoked by an extensive molecular repertoire of signalling components. Among these, reactive oxygen species (ROS) signalling, together with calcium signalling, plays a crucial role in controlling several physiopathological events. Although initially considered detrimental by-products of aerobic metabolism, it is now widely accepted that ROS, in subtoxic levels, act as signalling molecules. However, dysfunctions in the mechanisms controlling the physiological ROS concentration affect cellular homeostasis, leading to the pathogenesis of various disorders.
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RYR1 Sequence Variants in Myopathies: Expression and Functional Studies in Two Families. BIOMED RESEARCH INTERNATIONAL 2019; 2019:7638946. [PMID: 31165076 PMCID: PMC6500691 DOI: 10.1155/2019/7638946] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 03/19/2019] [Indexed: 12/26/2022]
Abstract
The skeletal muscle ryanodine receptor (RyR1), i.e., the Ca2+ channel of the sarco/endoplasmic reticulum (S/ER), and the voltage-dependent calcium channel Cav1.1 are the principal channels involved in excitation-contraction coupling in skeletal muscle. RYR1 gene variants are linked to distinct skeletal muscle disorders, including malignant hyperthermia susceptibility and central core disease (CCD), mainly with autosomal dominant inheritance, and autosomal recessive myopathies with a broad phenotypic and histopathological spectrum. The age at onset of RYR1-related myopathies varies from infancy to adulthood. We report the identification of four RYR1 variants in two Italian families: one with myopathy and variants c.4003C>T (p.R1335C) and c.7035C>A (p.S2345R), and another with CCD and variants c.9293G>T (p.S3098I) and c.14771_14772insTAGACAGGGTGTTGCTCTGTTGCCCTTCTT (p.F4924_V4925insRQGVALLPFF). We demonstrate that, in patient-specific lymphoblastoid cells, the c.4003C>T (p.R1335C) variant is not expressed and the in-frame 30-nucleotide insertion variant is expressed at a low level. Moreover, Ca2+ release in response to the RyR1 agonist 4-chloro-m-cresol and to thapsigargin showed that the c.7035C>A (p.S2345R) variant causes depletion of S/ER Ca2+ stores and that the compound heterozygosity for variant c.9293G>T (p.S3098I) and the 30-nucleotide insertion increases RyR1-dependent Ca2+ release without affecting ER Ca2+ stores. In conclusion, we detected and functionally characterized disease-causing variants of the RyR1 channel in patient-specific lymphoblastoid cells. This paper is dedicated to the memory and contribution of Luigi Del Vecchio.
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Breed D, Meyer LCR, Steyl JCA, Goddard A, Burroughs R, Kohn TA. Conserving wildlife in a changing world: Understanding capture myopathy-a malignant outcome of stress during capture and translocation. CONSERVATION PHYSIOLOGY 2019; 7:coz027. [PMID: 31304016 PMCID: PMC6612673 DOI: 10.1093/conphys/coz027] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 04/22/2019] [Accepted: 05/03/2019] [Indexed: 05/18/2023]
Abstract
The number of species that merit conservation interventions is increasing daily with ongoing habitat destruction, increased fragmentation and loss of population connectivity. Desertification and climate change reduce suitable conservation areas. Physiological stress is an inevitable part of the capture and translocation process of wild animals. Globally, capture myopathy-a malignant outcome of stress during capture operations-accounts for the highest number of deaths associated with wildlife translocation. These deaths may not only have considerable impacts on conservation efforts but also have direct and indirect financial implications. Such deaths usually are indicative of how well animal welfare was considered and addressed during a translocation exercise. Importantly, devastating consequences on the continued existence of threatened and endangered species succumbing to this known risk during capture and movement may result. Since first recorded in 1964 in Kenya, many cases of capture myopathy have been described, but the exact causes, pathophysiological mechanisms and treatment for this condition remain to be adequately studied and fully elucidated. Capture myopathy is a condition with marked morbidity and mortality that occur predominantly in wild animals around the globe. It arises from inflicted stress and physical exertion that would typically occur with prolonged or short intense pursuit, capture, restraint or transportation of wild animals. The condition carries a grave prognosis, and despite intensive extended and largely non-specific supportive treatment, the success rate is poor. Although not as common as in wildlife, domestic animals and humans are also affected by conditions with similar pathophysiology. This review aims to highlight the current state of knowledge related to the clinical and pathophysiological presentation, potential treatments, preventative measures and, importantly, the hypothetical causes and proposed pathomechanisms by comparing conditions found in domestic animals and humans. Future comparative strategies and research directions are proposed to help better understand the pathophysiology of capture myopathy.
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Affiliation(s)
- Dorothy Breed
- Division of Exercise Science and Sports Medicine, Department of Human Biology, University of Cape Town, Cape Town, South Africa
- Biodiversity Management Branch, Environmental Management Department, City of Cape Town, Maitland, South Africa
| | - Leith C R Meyer
- Department of Paraclinical Sciences, University of Pretoria, Onderstepoort, South Africa
- Centre for Veterinary Wildlife Studies, University of Pretoria, Onderstepoort, South Africa
| | - Johan C A Steyl
- Department of Paraclinical Sciences, University of Pretoria, Onderstepoort, South Africa
- Centre for Veterinary Wildlife Studies, University of Pretoria, Onderstepoort, South Africa
| | - Amelia Goddard
- Department of Companion Animal Clinical Studies, University of Pretoria, Onderstepoort, South Africa
- Centre for Veterinary Wildlife Studies, University of Pretoria, Onderstepoort, South Africa
| | - Richard Burroughs
- Department of Production Animal Studies, University of Pretoria, Onderstepoort, South Africa
- Centre for Veterinary Wildlife Studies, University of Pretoria, Onderstepoort, South Africa
- Mammal Research Institute, University of Pretoria, Onderstepoort, South Africa
| | - Tertius A Kohn
- Division of Exercise Science and Sports Medicine, Department of Human Biology, University of Cape Town, Cape Town, South Africa
- Department of Paraclinical Sciences, University of Pretoria, Onderstepoort, South Africa
- Corresponding author: Division of Exercise Science and Sports Medicine, Department of Human Biology, University of Cape Town, Boundary Road, Cape Town 7725, South Africa. Tel.: +27 21 406 6235;
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15
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A Case Report of Suspected Malignant Hyperthermia: How Will the Diagnosis Affect a Patient's Insurability? Case Rep Anesthesiol 2018; 2018:6532821. [PMID: 30510808 PMCID: PMC6232818 DOI: 10.1155/2018/6532821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 10/15/2018] [Accepted: 10/22/2018] [Indexed: 11/17/2022] Open
Abstract
The purpose of this case report is to increase awareness that a diagnosis of malignant hyperthermia may have long-lasting or permanent effects on a patient's insurance eligibility or premiums despite legislation providing varying levels of protection from preexisting conditions or genetic discrimination. We present a case of severe rigors, unexplained severe metabolic acidosis, and severe hyperthermia in a patient after general anesthesia for extensive head and neck surgery. The patient was treated for malignant hyperthermia and demonstrated a significant clinical improvement with the administration of dantrolene. Even with an “almost certain” diagnosis of malignant hyperthermia by clinical presentation, genetic testing was negative and the gold-standard caffeine-halothane contracture test has yet to be performed. Laboratory results, clinical grading scales, and genetic testing support a diagnosis of malignant hyperthermia but the gold standard is a live muscle biopsy and caffeine-halothane contracture test. A clinical diagnosis of MH or a positive caffeine-halothane contracture test could result in exclusion from genetic discrimination legislature due to the fact that diagnosis can be confirmed without genetic testing. The fate of the Affordable Care Act may also affect how insurance companies scrutinize this disease. Improving accuracy of MH diagnosis in hospital discharge records will be crucial.
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16
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A comprehensive review of malignant hyperthermia: Preventing further fatalities in orthopedic surgery. J Orthop 2018; 15:578-580. [PMID: 29881197 DOI: 10.1016/j.jor.2018.05.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 05/06/2018] [Indexed: 12/13/2022] Open
Abstract
Most frequently associated with orthopedic surgery, malignant hyperthermia is a rare genetic condition linked to volatile anesthetics and succinylcholine. If not treated quickly with appropriate measures, death may result. To aid in the prevention of further fatalities, this review seeks to educate clinicians and staff on the presentation and treatment of this disease, as well as to provide a comprehensive overview by further addressing prevalence, similar conditions, pathogenesis and other aspects. Although the number of deaths due to malignant hyperthermia has greatly declined in the last several years, increased knowledge may eliminate associated mortalities, particularly in the orthopedic setting.
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17
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Updated guide for the management of malignant hyperthermia. Can J Anaesth 2018; 65:709-721. [DOI: 10.1007/s12630-018-1108-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 02/05/2018] [Accepted: 02/10/2018] [Indexed: 11/30/2022] Open
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18
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Thrift E, Wimpole JA, Child G, Brown N, Gandolfi B, Malik R. Exercise-induced hyperthermia syndrome (canine stress syndrome) in four related male English springer spaniels. VETERINARY MEDICINE (AUCKLAND, N.Z.) 2017; 8:59-68. [PMID: 30050857 PMCID: PMC6042503 DOI: 10.2147/vmrr.s123836] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE This retrospective study describes the signalment, clinical presentation, diagnostic findings, and mode of inheritance in four young male English springer spaniel dogs with presumptive canine stress syndrome. MATERIALS AND METHODS Appropriate cases were located through medical searches of medical records of two large private referral centers. Inclusion criteria comprised of English springer spaniel dogs with tachypnea and hyperthermia that subsequently developed weakness or collapse, with or without signs of hemorrhage, soon after a period of mild-to-moderate exercise. The pedigrees of the four affected dogs, as well as eleven related English springer spaniels, were then analyzed to determine a presumptive mode of genetic inheritance. RESULTS Four dogs met the inclusion criteria. All four were male, suggesting the possibility of a recessive sex-linked heritable disorder. Pedigree analysis suggests that more dogs may be potentially affected, although these dogs may have never had the concurrent triggering drug/activity/event to precipitate the clinical syndrome. There was complete resolution of clinical signs in three of the four dogs with aggressive symptomatic and supportive therapy, with one dog dying during treatment. CONCLUSION Dogs with canine stress syndrome have the potential for rapid recovery if treated aggressively and the complications of the disease (eg, coagulopathy) are anticipated. All four dogs were male, suggesting the possibility of a recessive sex-linked mode of inheritance. Further genetic analyses should be strongly considered by those involved with the English springer spaniel breed, either with a genome-wide association study using canine single-nucleotide polymorphism arrays or whole-genome sequencing of affected and closely related dogs.
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Affiliation(s)
| | | | - Georgina Child
- Small Animal Specialist Hospital, Sydney, NSW, Australia
| | | | - Barbara Gandolfi
- Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri, Columbia, MO, USA
| | - Richard Malik
- Centre for Veterinary Education, University of Sydney, Sydney, NSW, Australia
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19
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Huh H, Jung JS, Park SJ, Park MK, Lim CH, Yoon SZ. Successful early application of extracorporeal membrane oxygenation to support cardiopulmonary resuscitation for a patient suffering from severe malignant hyperthermia and cardiac arrest: a case report. Korean J Anesthesiol 2017; 70:345-349. [PMID: 28580087 PMCID: PMC5453898 DOI: 10.4097/kjae.2017.70.3.345] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 12/08/2016] [Accepted: 12/12/2016] [Indexed: 12/12/2022] Open
Abstract
Malignant hyperthermia (MH) may lead to metabolic crisis of skeletal muscle in susceptible individuals following exposure to triggering agents such as volatile anesthetics or depolarizing muscle relaxants. MH is a rare and a potentially lethal disease, which can lead to cardiac arrest. We report a case of severe MH, in which the rapidly evolving signs of hypermetabolism eventually resulted in cardiac arrest. Despite conventional treatments following cardiopulmonary resuscitation, the patient's vital signs did not improve. Therefore, we applied extracorporeal membrane oxygenation for providing hemodynamic support.
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Affiliation(s)
- Hyub Huh
- Department of Anesthesiology and Pain Medicine, Korea University College of Medicine, Seoul, Korea
| | - Jae Seung Jung
- Department of Thoracic and Cardiovascular Surgery, Korea University College of Medicine, Seoul, Korea
| | - Sang Jae Park
- Department of Anesthesiology and Pain Medicine, Korea University College of Medicine, Seoul, Korea
| | - Min Kyung Park
- Department of Anesthesiology and Pain Medicine, Korea University College of Medicine, Seoul, Korea
| | - Choon Hak Lim
- Department of Anesthesiology and Pain Medicine, Korea University College of Medicine, Seoul, Korea
| | - Seung Zhoo Yoon
- Department of Anesthesiology and Pain Medicine, Korea University College of Medicine, Seoul, Korea
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20
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Burckhardt BC, Henjakovic M, Hagos Y, Burckhardt G. Counter-flow suggests transport of dantrolene and 5-OH dantrolene by the organic anion transporters 2 (OAT2) and 3 (OAT3). Pflugers Arch 2016; 468:1909-1918. [DOI: 10.1007/s00424-016-1894-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 09/27/2016] [Accepted: 10/11/2016] [Indexed: 11/29/2022]
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21
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Hernández-Ochoa EO, Pratt SJP, Lovering RM, Schneider MF. Critical Role of Intracellular RyR1 Calcium Release Channels in Skeletal Muscle Function and Disease. Front Physiol 2016; 6:420. [PMID: 26793121 PMCID: PMC4709859 DOI: 10.3389/fphys.2015.00420] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 12/21/2015] [Indexed: 01/25/2023] Open
Abstract
The skeletal muscle Ca2+ release channel, also known as ryanodine receptor type 1 (RyR1), is the largest ion channel protein known and is crucial for effective skeletal muscle contractile activation. RyR1 function is controlled by Cav1.1, a voltage gated Ca2+ channel that works mainly as a voltage sensor for RyR1 activity during skeletal muscle contraction and is also fine-tuned by Ca2+, several intracellular compounds (e.g., ATP), and modulatory proteins (e.g., calmodulin). Dominant and recessive mutations in RyR1, as well as acquired channel alterations, are the underlying cause of various skeletal muscle diseases. The aim of this mini review is to summarize several current aspects of RyR1 function, structure, regulation, and to describe the most common diseases caused by hereditary or acquired RyR1 malfunction.
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Affiliation(s)
- Erick O Hernández-Ochoa
- Department of Biochemistry and Molecular Biology, University of Maryland School of Medicine Baltimore, MD, USA
| | - Stephen J P Pratt
- Department of Orthopaedics, University of Maryland School of Medicine Baltimore, MD, USA
| | - Richard M Lovering
- Department of Orthopaedics, University of Maryland School of Medicine Baltimore, MD, USA
| | - Martin F Schneider
- Department of Biochemistry and Molecular Biology, University of Maryland School of Medicine Baltimore, MD, USA
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22
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Satuito M, Tom J. Potent Inhalational Anesthetics for Dentistry. Anesth Prog 2016; 63:42-8; quiz 49. [PMID: 26866411 PMCID: PMC4751520 DOI: 10.2344/0003-3006-63.1.42] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 11/17/2015] [Indexed: 11/11/2022] Open
Abstract
Nitrous oxide and the volatile inhalational anesthetics have defined anxiety and pain control in both dentistry and medicine for over a century. From curious experimentation to spectacular public demonstrations, the initial work of 2 dentists, Horace Wells and William T. G. Morton, persists to this day in modern surgery and anesthesia. This article reviews the history, similarities, differences, and clinical applications of the most popular inhalational agents used in contemporary dental surgical settings.
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Affiliation(s)
- Mary Satuito
- Dentist Anesthesiologist, Division 1: Health Promotion, Disease Prevention, and Community Health Programs, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, California
| | - James Tom
- Dentist Anesthesiologist, Divisions 1 & 3, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, California
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23
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Alvarellos ML, McDonagh EM, Patel S, McLeod HL, Altman RB, Klein TE. PharmGKB summary: succinylcholine pathway, pharmacokinetics/pharmacodynamics. Pharmacogenet Genomics 2015; 25:622-30. [PMID: 26398623 PMCID: PMC4631707 DOI: 10.1097/fpc.0000000000000170] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
| | | | - Sephalie Patel
- Department of Anesthesiology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Howard L. McLeod
- DeBartolo Family Personalized Medicine Institute, Moffitt Cancer Center, Tampa, Florida, USA
| | - Russ B. Altman
- Department of Genetics, Stanford University, Stanford, California, USA
- Department of Bioengineering, Stanford University, Stanford, California, USA
| | - Teri E. Klein
- Department of Genetics, Stanford University, Stanford, California, USA
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24
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Valk MJ, Loer SA, Schober P, Dettwiler S. Perioperative considerations in Walker-Warburg syndrome. Clin Case Rep 2015; 3:744-8. [PMID: 26401279 PMCID: PMC4574790 DOI: 10.1002/ccr3.334] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 05/25/2015] [Accepted: 06/24/2015] [Indexed: 11/07/2022] Open
Abstract
Walker-Warburg syndrome is a rare congenital disorder. Several features, including muscular dystrophy, hydrocephalus, and oropharyngeal abnormalities, have important implications in the perioperative setting. We present a case of general anesthesia in an infant and discuss perioperative considerations to guide clinicians faced with the management of patients with this syndrome.
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Affiliation(s)
- Madelous Ja Valk
- Department of Anesthesiology, VU University Medical Center De Boelelaan 1117, 1007 MB, Amsterdam, The Netherlands
| | - Stephan A Loer
- Department of Anesthesiology, VU University Medical Center De Boelelaan 1117, 1007 MB, Amsterdam, The Netherlands
| | - Patrick Schober
- Department of Anesthesiology, VU University Medical Center De Boelelaan 1117, 1007 MB, Amsterdam, The Netherlands
| | - Saskia Dettwiler
- Department of Anesthesiology, VU University Medical Center De Boelelaan 1117, 1007 MB, Amsterdam, The Netherlands
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25
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Ou MC, Ruan Q, Li Y. Postoperative hyperthermia after resection of a seminoma from the thalamus and third ventricle. Int J Clin Exp Med 2014; 7:5943-5946. [PMID: 25664139 PMCID: PMC4307586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 11/24/2014] [Indexed: 06/04/2023]
Abstract
Hyperthermia is relatively common in inpatients, but hyperthermia occurring in the immediate postoperative period after undergoing neurosurgery has some unique characteristics. This case report concerns a patient who developed immediate postoperative hyperthermia up to 39.3°C (the axillary temperature) in the post-anesthesia care unit (PACU) after resection of a seminoma from the thalamus and third ventricle. Having been re-intubated and mechanically ventilated, the elevated temperature was treated on the PACU by cooling the skin with ice and antipyretic drugs. Within 2 hours after the surgery, the patient's body temperature had fallen to 37.8°C and vital signs were stable. The patient was then transferred to the neurology intensive care unit for further management. The patient was discharged 70 days after surgery with normal body temperature. During excision of a space-occupying lesion in the thalamus or hypothalamus, clinicians must be mindful of the possibility of hyperthermia and administer appropriate treatments immediately.
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Affiliation(s)
- Meng-Chan Ou
- Department of Anesthesiology, West China Hospital, Sichuan University Chengdu 610041, China
| | - Qian Ruan
- Department of Anesthesiology, West China Hospital, Sichuan University Chengdu 610041, China
| | - Yu Li
- Department of Anesthesiology, West China Hospital, Sichuan University Chengdu 610041, China
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