- 期刊
Delayed Onset of Sevoflurane-induced Juvenile Malignant Hyperthermia after Second Exposure
二次曝光Sevoflurane所引發之延遲性小兒惡性高熱－病例報告
摘要
惡性高熱是一個不常見的全身麻醉相關併發症，過去有相當多的文獻報導，特別是halothane所引發的惡性高熱更是被界定的相當清楚。然而近年sevoflurane及desflurane的使用成為主流，在文獻回顧中，sevoflurane及desflurane被認為是較不易引起惡性高熱之氣體麻醉劑，且desflurane所導致的惡性高熱症狀有可能是不易辨認的延遲性非典型症狀。我們報告了一個使用sevoflurane後所引發的惡性高熱病例，本例的兩個獨特性在於本例發生在病人第二次接受sevoflurane麻醉時發生惡性高熱，且發生的過程延遲而緩慢。其次本例於接受sevoflurane麻醉中緩慢增加心跳速率是這次惡性高熱發作的唯一早期症狀。因此，這份報告旨在提醒麻醉醫師過去曾接受麻醉的病患仍然有發生惡性高熱的可能，同時以sevoflurane或desflurane為主的臨床麻醉中，應注意惡性高熱延遲發作的可能，並對非典型症狀提高警覺。
並列摘要
Malignant hyperthermia (MH) is a rare condition consisting of increased temperature and rigidity with mild to fulminant manifestation during anesthesia. Sevoflurane was thought to be a less potent triggering agent of MH; however, in literature review, the onset of MH after exposure to sevoflurane may be associated with calcium release from the sarcoplasmic reticulum. We present here a case of rarely-seen delayed MH induced by an inhalation agent of low-inducing probability, sevoflurane, after the second exposure to which within a short period of time. The patient was a five years old boy who received sevoflurane anesthesia for repeat orthopedic surgery within two days. Gradual elevation in heart rate, abrupt hypercarbia and hyperthermia were observed 90 min after induction. Dantrolene was administrated immediately with effective therapeutic response. Eventually, the patient recovered without any complication as an aftermath. Gradually elevated heart rate during the second exposure to sevoflurane was the atypical sign in the episode of MH in this case. One plausible explanation for the development of delayed onset of MH is the latent effect of the volatile anesthetic on the skeletal muscles. Therefore, it is worth noting for the anesthesiologists to recognize the possibility of an atypical MH and be alert for the possible occurrence of MH during routine anesthetic practice.