Abstract
A 28-year-old man was scheduled for tonsillectomy under general anesthesia. Anesthesia was induced with thiopental, and tracheal intubation was facilitated with succinylcholine (SCC). Anesthesia was maintained with halothane, nitrous oxide and oxygen. Following the operation was started, tachycardia and multifocal PVCs were observed. This arrhythmia was responded to acebutolol. However arterial blood gas analysis showed severe respiratory and metabolic acidosis. Airway obstruction was strongly suspected because of the small size of nasoendotracheal tube (6.5mmID). Following SCC injection for reintubation, muscular rigidity was observed. Malignant hyperthermia (MH) was suspected at this point, and the treatment of MH such as body cooling and dantrolene sodium I.V. were started. Laboratory data of CPK, LDH, urine and serum myoglobin, GOT and GPT remained high level for 4 weeks after anesthesia. Muscle biopsy in 14th postoperative day showed the acceleration of Ca-induced Ca release. The patient was discharged uneventfully. Anesthesiologist could not get the history of MH, however this patient had a cousin with MH.
It should be emphasized that the early symptoms of MH are very similar to airway obstruction or light anesthesia. The differential diagnosis of MH is rather difficult, but should be made promptly.
