術後発症した亜型悪性高熱症の1例

抄録

A 59-year-old man underwent total gastrectomy under general anesthesia uneventfully. On the second day after the operation, he developed a fever of over 39°C accompanied by tachycardia, metabolic acidosis, and oliguria which was resistant to conservative treatment. At the same time he complained of muscle pain and slight rigidity of the extremities. A detailed examination revealed a significant increase in serum CPK, LDH, GOT, GPT levels, and leucopenia below 2, 500/mm³, suggesting intraperitoneal infection and necrosis of the intestine. On the third postoperative day, an emergency operation was performed. However we could not obtain any abnormal findings in the peritoneal cavity. During the operation port wine-like myoglobulinuria was observed, so we suspected malignant hyperthermia. Intravenous dantrolene was effective in preventing renal failure and disseminated intravascular coagulopathy. Stress in the postoperative period may have been the triggering factor responsible for this reaction.