Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942003000100007
Brazilian Journal of Anesthesiology
Clinical Information

Anestesia para cirurgia ortopédica em criança com susceptibilidade à hipertermia maligna: relato de caso

Anesthesia for orthopedic surgery in a child susceptible to malignant hyperthermia: case report

Renato Santiago Gomez; Yerkes Pereira Silva; Cristiano Pereira Peluso

http://dx.doi.org/10.1590/S0034-70942003000100007 Braz J Anesthesiol, vol.53, n1, p.52-57, 2003
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Resumo

JUSTIFICATIVA E OBJETIVOS: Hipertermia maligna é uma miopatia autossômica dominante desencadeada por anestésicos inalatórios e bloqueadores neuromusculares, como halotano e succinilcolina, causando aumento da temperatura que pode ser fatal sem o tratamento imediato. O objetivo deste relato é descrever a conduta anestésica em uma criança susceptível à hipertermia maligna que foi submetida a procedimento cirúrgico ortopédico. RELATO DO CASO: Paciente do sexo feminino, com 3 anos, portadora de luxação congênita do quadril e susceptibilidade à hipertermia maligna, conforme história de anestesia anterior, foi submetida à correção cirúrgica ortopédica sob anestesia geral, com propofol e fentanil, associada à anestesia peridural lombar. A temperatura da paciente foi monitorizada continuamente durante a cirurgia e no período pós-operatório. A paciente apresentou recuperação pós-operatória sem intercorrências e recebeu alta hospitalar após cinco dias. CONCLUSÕES: A combinação de anestesia regional e venosa para o procedimento cirúrgico proposto em paciente com susceptibilidade à hipertermia maligna permitiu a condução anestésica com segurança.

Palavras-chave

ANALGÉSICOS, ANALGÉSICOS, ANESTÉSICOS, ANESTÉSICOS, CIRURGIA, CIRURGIA, DOENÇA, DOENÇA, HIPNÓTICOS, TÉCNICAS ANESTÉSICAS, TÉCNICAS ANESTÉSICAS

Abstract

BACKGROUND AND OBJECTIVES: Malignant hyperthermia is an autosomal dominant myopathy triggered by inhalational anesthetics and neuromuscular blockers, such as halothane and succinylcholine, which causes temperature increases that may be fatal if not promptly treated. This report aimed at describing anesthesia in a child susceptible to malignant hyperthermia submitted to orthopedic surgery. CASE REPORT: Female patient, 3 years of age, with congenital hip dislocation and susceptible to malignant hyperthermia, according to anesthetic history, who was submitted to corrective orthopedic surgery under general anesthesia with propofol and fentanyl, combined with lumbar epidural anesthesia. Temperature was closely monitored during surgery and in the postoperative period. Postoperative recovery was uneventful and patient was discharged five days later. CONCLUSIONS: Combined regional and intravenous anesthesia for the surgical procedure proposed to a patient susceptible to malignant hyperthermia allowed a safe anesthetic approach.

Keywords

ANALGESICS, ANALGESICS, ANESTHETICS, ANESTHETICS, ANESTHETIC TECHNIQUES, ANESTHETIC TECHNIQUES, DISEASE, DISEASE, HIPNOTICS, SURGERY, SURGERY

References

Jurkat-Rott K, McCarthy T, Lehmann-Horn F. Genetics and pathogenesis of malignant hyperthermia. Muscle Nerve. 2000;23:4-17.

Levitt RC. Prospects for the diagnosis of malignant hyperthermia susceptibility using molecular genetic approaches. Anesthesiology. 1992;76:1039-1048.

Wappler F. Malignant hyperthermia. Eur J Anaesthesiol. 2001;18:632-652.

Denborough M. Malignant hyperthermia. Lancet. 1998;352:1131-1136.

Nelson TE, Flewellen EH. The malignant hyperthermia syndrome. N Engl J Med. 1983;309:416-418.

Ball SP, Johnson KJ. The genetics of malignant hyperthermia. J Med Genet. 1993;30:89-93.

Larach MG. Should we use muscle biopsy to diagnose malignant hyperthermia susceptibility. Anesthesiology. 1993;79:1-4.

A protocol for the investigation of malignant hyperpyrexia (MH) susceptibility. Br J Anaesth. 1985;56:1267-1269.

Standardization of the caffeine halothane muscle contracture test. Anesth Analg. 1989;69:511-515.

Fletcher JE, Rosenberg H, Aggarwal M. Comparison of European and North American malignant hyperthermia diagnostic protocol outcomes for use in genetic studies. Anesthesiology. 1999;90:654-661.

Rosenberg H, Fletcher JE, Seitman D. Pharmacogenetics. Clinical Anesthesia. 1997:489-517.

Allen GC, Brubaker CL. Human malignant hyperthermia associated with desflurane anesthesia. Anesth Analg. 1998;86:1328-1331.

Larach MG, Localio AR, Allen GC. A clinical grading scale to predict malignant hyperthermia susceptibility. Anesthesiology. 1994;80:771-779.

Rosenberg H, Reeds S. In vitro contracture tests for susceptibility to malignant hyperthermia: diagnostic dilemma. Anesth Analg. 1983;62:415-420.

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