恶性高热will2015-10-12研讨.pptxVIP

Case Report CASE An 8-day-old boy was scheduled bilateral nasopharyngeal tube application under general anesthesia Preoperative examination: Laboratory tests √ X-ray √ b-scan ultrasound √ ECG √ Medical history ：scheduled for choanal atresia evaluation under general anesthesia one week ago  body examination ： syndromic facial appearance， micrognathia, low-set ears, popeyed appearance, hypertelorism, palpebral fissures, cryptrochidism, clinodactyly, and bilateral hearing loss 小颌畸形,低位耳,双眼突出,眼距过宽, 睑裂,隐睾,小指内弯, 双边听力损失 CASE sevoflurane 7-8% remifentanil 2 ??g Intubation Anesthesia lasted 35 minutes without muscle relaxant Extubation The procedure ended without any problem Followup : temperature increased to 42.5°C,heart rate increased to 250/min, and respiratory distress developed. Creatinine phosphokinase levels reached929 IU/L, and hyperpotassemia developed. Blood gas analysisrevealed hypoxemia (SO2 85%), respiratory acidosis(PaCO2 60 mm Hg) and metabolic acidosis (base deficit 10 mEq/L) CASE Treatment Dantrolene sodium was given orally body temperature minimally decreasedrespiratory distress continued Intubated and mechanical ventilation Dantrolen sodium 2.5 mg/kg was givenintravenously with 6-hours intervals for 2 days temperature decreased Extubated and CPAP was done 10-hours period of intubation Spo2 PACO2 Case ReportDelayed Onset Malignant Hyperthermia after Sevoflurane Malignant Hyperthermia Malignant Hyperthermia Malignant Hyperthermia H H HOW Malignant Hyperthermia ? Epidemiology? High risk？ Clinical features？ Laboratory tests？ Pathophysiology? Malignant Hyperthermia 恶性高热（Malignant Hyperthermia，MH）是目前所知的唯一可由常规麻醉用药引起围手术期死亡的遗传性疾病。它是一种亚临床肌肉病，即患者平时无异常表现，在全麻过程中接触挥发性吸入麻醉药（如氟烷、安氟醚、异氟醚等）和去极化肌松药（琥珀胆碱）后出现骨骼肌强直性收缩，产生大量能量，导致体温持续快速增高，在没有特异性治疗药物的情况下，一般的临床降温措施难以控制体温的增高，最终可导致患者死亡。 Epidemiology Epidemiology Audlt Female Foreign Child Male China Age Ge