Malignant hyperpyrexia during anaesthesia for colectomy.

Abstract

Malignant hyperpyrexia associated with anaesthesia is a condition which is increasingly attracting the attention of anaesthetists and surgeons. Initially most reports came from the North American Continent (Canad. Anaesth. Soc. 7., 1966;Stephen, 1967), but it now appears that a number of cases have occurred in Britain (Brit. med. 7., 1968). The following report illustrates such a case. CASE REPORTThe patient, a 20-year-old man, was a routine list case for total colectomy and ileorectal anastomosis. He had a history of two severe attacks of typical ulcerative colitis which had responded adequately but not completely to medical treatment. Two squint operations at the age of 4 years had been performed without incident, and two siblings and both parents had operations under general anaesthesia quite uneventfully. Immediately before operation his temperature was normal and his resting pulse rate was 90.After premedication with papaveretum 20 mg. and hyoscine 0 4 mg. he was conscious and co-operative. Induction of anaesthesia at 8.50 a.m. (0 hours) with methohexitone 100 mg. and suxamethonium 75 mg. was normal and uneventful, and an endotracheal tube was passed. The action and duration of the suxamethonium were normal and the patient was allowed to breathe spontaneously while sigmoidoscopy was performed. At 20 minutes tubocurarine 45 mg. and pethidine 30 mg. were given, and his respirations were completely controlled on the East-Radcliffe ventilator with a mixture of oxygen 3 l., nitrous oxide 5 1., and halothane 0-25 %. Relaxation was complete and the operation was begun. The systolic blood pressure stabilized at 120 mm. Hg and the pulse rate at 120. An intravenous infusion of Ringer lactate solution was started.Operation and anaesthesia proceeded quite normally and uneventfully, and regular monitoring of pulse and blood pressure showed no change from the original measurements. The tachycardia was attributed to the nature of the patient's disease. At 1 hour 30 minutes the first bottle of blood (group Q rhesus-negative) was set up.At 1 hour 55 minutes the soda lime canister on the ventilator was noticed to be warmer than normal. The patient was also observed to be sweating slightly around the mouth. The pulse and blood pressure remained as before. His lips were then noted to be slightly cyanosed, and the anaesthetic equipment, tubing, and endotracheal tube were at once checked. His colour then deteriorated more generally and ventilation was continued with pure oxygen, which quickly improved his colour. He was then seen to be sweating more freely, and was for the first time felt to be quite hot.