Recurrent malignant hyperthermia after scoliosis correction surgery

doi:10.5847/wjem.j.1920-8642.2024.006

Abstract

Junfeng Su, Man Huang. Recurrent malignant hyperthermia after scoliosis correction surgery[J]. World Journal of Emergency Medicine, 2024, 15(1): 70-72.

Figures/Tables 1

Table 1.

Patient's condition after operation

Date (after operation)	Shivering frequency	T_max (℃)	ETCO_2max (mmHg)	CK_max	Sedation	Respiratory support	Dantrolene usage	Dantrolene dose (mg)
D0 (ICU admission)	No shivering	37.1	45	1,591	Propofol+remifentanil RASS score: -4 to -2	Mechanical ventilation with FiO₂: 100%, PEEP: 5 cmH₂O, SpO₂ ≥94%	40 mg iv. Q6h (1 iv)	40
D1	5 times, continued for 1 min per time	37.7	43	6,450	Propofol+remifentanil RASS score: -4 to -2	Mechanical ventilation with FiO₂: 40%, PEEP: 5 cmH₂O, SpO₂ ≥94%	40 mg iv. Q6h (4 iv) & 40 mg bolus	200
D2	5 times, continued for 1 min, 1 min, 2 min, 1 min, and 10 min, respectively	39.5	54	8,310	Midazolam+remifentanil RASS score: -4 to -2	Mechanical ventilation with FiO₂: 40%, PEEP: 5 cmH₂O, SpO₂ ≥94%	40 mg iv. Q6h (4 iv)	160
D3	2 times, continued for 10 min, and 30 min, respectively	38.5	56	8,060	Midazolam+remifentanil RASS score: -4 to -2	Mechanical ventilation with FiO₂: 40%, PEEP: 8 cmH₂O, SpO₂ ≥94%	40 mg bolus (2 iv) & 40 mg iv. Q6h (3 iv)	200
D4	4 times, continued for 30 min, 30 min, 30 min, and 50 min, respectively	38.0	58	4,210	Propofol+midazolam+remifentanil RASS score: -4 to -2	Mechanical ventilation with FiO₂: 40%, PEEP: 8 cmH₂O, SpO₂ ≥94%	60 mg iv. Q6h (4 iv) & 60 mg bolus	300
D5	1 time, continued for 15 min	38.8	55	3,500	Propofol+midazolam+sufentanil RASS score: -4 to -2	Mechanical ventilation with FiO₂: 40%, PEEP: 8 cmH₂O, SpO₂ ≥94%	60 mg iv. Q6h (4 iv)	240
D6	4 times, continued for 5 min, 6 min, 5 min, and 5 min, respectively	38.6	51	2,700	Propofol+midazolam+sufentanil RASS score: -4 to -2	Mechanical ventilation with FiO₂: 40%, PEEP: 8 cmH₂O, SpO₂ ≥94%	60 mg iv. Q6h (3 iv) & iv.vp. 10 mg/h for 3 h	210
D7	5 times, continued for 7 min, 20 min, 10 min, 10 min, and 12 min respectively	38.9	56	2,700	Propofol+midazolam+sufentanil RASS score: -4 to -2	Mechanical ventilation with FiO₂: 40%, PEEP: 8 cmH₂O, SpO₂ ≥94%	iv.vp. 10 mg/h for 7 h & 60 mg iv. Q6h (4 iv)	310
D8	3 times, continued for 12 min, 6 min, and 8 min, respectively	38.0	53	12,330	Desist from sedation	Removal of endotracheal intubation & high-flow oxygen therapy (flow rate 35 L/min, oxygen concentration 40%, SpO₂ ≥94%)	60 mg iv. Q6h (4 iv)	240
D9	Persistent weak shivering for 120 min	39.3	-	12,800	-	High-flow oxygen therapy (flow rate 35L/min, oxygen concentration 50%-100%, SpO₂ ≥94%)	60 mg iv. Q6h (4 iv)	240
D10	Shivering for 10 min, persistent weak shivering for hours	38.9	-	8,020	-	Sat beside the bed (for rehabilitation exercise) for 30 min in the late morning with nasal catheter oxygen inhalation 5 L /min, SpO₂ 91%-95%, and continued to tremble in the afternoon, then high-flow oxygen therapy (flow rate 25 L/min, oxygen concentration 50%-55%, SpO₂ ≥94%)	60 mg iv. Q6h (2 iv) & 40 mg iv. Q6h (2 iv)	200
D11	No shivering	37.7	-	3,700	-	Nasal catheter oxygen inhalation 5 L /min, SPO₂ ≥94%	60 mg bolus & 40 mg bolus then stop dosing	100
D12	No shivering	37.3	-	-	-	Nasal catheter oxygen inhalation 5 L/min, SpO₂ ≥94%	-	0
D13	No shivering	36.9	-	-	-	Nasal catheter oxygen inhalation 5 L/min, SpO₂ ≥94%	-	0
D14 (left ICU)	Weak shivering (head and limbs) improved automatically in a few minutes	37.4	-	-	-	Nasal catheter oxygen inhalation 5 L/min, SpO₂ ≥94% Transfered to orthopedic ward	-	0
D15-D35	No shivering	<37.5	-	D15 (920) D19 (645)		Nasal catheter oxygen inhalation 3 L/min, SpO₂ ≥94% (D15); no oxygen inhalation (D16-D35)	-	0

Table 1.

References 16

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Recurrent malignant hyperthermia after scoliosis correction surgery

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