Hyperpyrexia during anaesthesia in a second member of a family, with associated coagulation defect due to increased intravascular coagulation

Abstract

HYPERPYREXIA following anaesthesia, and associated with an abnormal reaction to succinylcholine (Anectine| though rare, has been the subject of a number of reports recently. 1-4 The following case is reported to alert anaesthetists to a possible familial tendency to hyperthermia, and the simultaneous occurrence of an alteration in the coagulating mechanisms of the blood. A married woman of French-Canadian descent, aged 44, was anaesthetized on December 14, 1966, for excision biopsy of a mass in the left breast, followed by radical mastectomy. Preoperatively, her history, physical examination and laboratory tests (see Table I) indicated normal health. Prior to the induction of anaes-TABLE I ELECTROLYTE CHANGES IN A CASE OF HYPERTHERMIA

Hyperpyrexia During Anaesthesia

“…Pari passu a gross metabolic and respiratory acidosis was evident. Whereas the limbs of the normal anaesthetized pig are relaxed during anaesthesia-even light anaesthesia-the limbs of the hyperpyrexial pigs were stiffly extended, the muscles in extreme spasm in a way similar to that described by Hall et al (1966) in their pigs and by the Canadian workers (Cullen, 1966 ;Davies and Graves, 1966;Hogg and Renwick, 1966;Lavoie, 1966;Relton et al, 1966;Thut and Davenport, 1966;Purkis et al, 1967) in the hyperpyrexial humans following the suxamethonium they postulated as being responsible for this condition. We did not observe any marked change in pulmonary compliance.…”

“…The baffling and frightening complication of malignant hyperpyrexia occurring during anaesthesia has been described in humans by many authors (Cullen, 1966 ;Davies and Graves, 1966;Hogg, and Renwick, 1966;Lavoie, 1966;Relton et al., 1966;Thut and Davenport, 1966;Purkis et al, 1967) and in anaesthetized pigs by Hall et al (1966). Most of these workers attribute this unpredictable, lethal, and puzzling reaction to suxamethonium, genetically determined.…”

Fulminating Hyperthermia and General Anaesthesia

“…A number of such occurrences have been published, mainly in Canada (Saidman et al, 1964;Cullen, 1966;Davies and Graves, 1966;Hogg and Renwick, 1966; Lavoie, 1966;Relton et al, 1966 ;Thut and Davenport, 1966;Purkis et al, 1967;Stephen, 1967), but we know of only one other comparable case so far recorded in the British Isles (Brown, 1954).…”

Hyperpyrexia During Anaesthesia

“…med.J., 1968, 3, 594-595 S ummary: Work in pigs has shown that malignant hyperpyrexia during anaesthesia may occur without suxamethonium having been given. A virtually constant feature in reported cases and in our own observations is that all subjects developing hyperpyrexia had received nitrous oxide and halothane.The baffling and frightening complication of malignant hyperpyrexia occurring during anaesthesia has been described in humans by many authors (Cullen, 1966 ;Davies and Graves, 1966;Hogg, and Renwick, 1966; Lavoie, 1966;Relton et al., 1966;Thut and Davenport, 1966;Purkis et al, 1967) stiffly extended, the muscles in extreme spasm in a way similar to that described by Hall et al (1966) in their pigs and by the Canadian workers (Cullen, 1966 ;Davies and Graves, 1966;Hogg and Renwick, 1966; Lavoie, 1966;Relton et al, 1966;Thut and Davenport, 1966;Purkis et al, 1967) in the hyperpyrexial humans following the suxamethonium they postulated as being responsible for this condition. We did not observe any marked change in pulmonary compliance.…”