Abstract
We report a rare care of malignant hyperthermia with recurring of symptoms. The patient is a 15-year-old boy who had invasive osteosynthesis (8 months ago) when fevers of unknown etiology were observed. Eight months later, he was scheduled for a rod removal. During anesthesia with isoflurane and nitrous oxide, his body temperature was elevated (1.8°C•30min-1) in association with tachycardia, hypertension and hypercarbia. Operation was completed shortly and he was transferred to the ICU. The highest body temperature was 42.5°C (1 POD) and the highest urinary myoglobin was 1, 370, 000μg•l-1 (5 POD). In addition to whole-body cooling and vigorous hyperventilation, dantrolene (60mg) was administered. His body temperature slowly decreased. He was discharged from the ICU on the 3 POD without any symptoms. Laboratory data improved to nearly normal on the 8 POD. However, on the 12 POD, intense sweating, fever (38°C), and hypermyoglobinemia (64, 700μg•l-1) was recognized. Oral dantrolene (75mg•day-1) was started on the 15 POD. His symptoms improved slowly and the patient with discharged with no sequelae on the 42 POD.
It is suggested that malignant hyperthermia may recur in a short period of time even after the improvement of symptoms.
