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Objective: To discuss the early diagnosis of malignant hyperthermia (MH) and its treatment regimen without dantrolene. Methods: A patient of American Society of Anesthesiologist class I had sudden muscle spasms and masseter muscle spasm during induction of anesthesia for idiopathic scoliosis surgery, and was diagnosed as having MH. Without using dantrolene, the patient was treated promptly with removal of inducement, control of temperature, adequate oxygen supply, maintaining of pH, water and electrolyte balance, and protection of renal function. The dynamic changes of the myoglobin in the blood and urine, serum creatine kinase, the blood gas indicators, and EtCO2, together with the pathological changes of the quadriceps were observed. Our experience on diagnosis and treatment was summarized. Results: The patient fully recovered and was discharged without any complications. The myoglobin in the blood and urine, serum creatine kinase and its isoenzyme increased rapidly and reached the peak one hour after MH, and maintained for about ten hours, then returned gradually to normal level about five days later. The temperature and EtCO2, increased immediately after development of MH, arterial blood gas quickly showed hypercapnic acidosis, but pH maintained normal or partial alkali during the treatment due to sodium bicarbonate administration; the alkali maintained obviously higher. Some quadriceps muscle cell had vacuolar degeneration and lysis. Conclusion: Non-ventilation induced increase of EtCO2 is a reliable indicator for early diagnosis of MH. Anesthetics, such as succinylcholine, should be avoided in patients at high risk of MH, and EtCO2 should be monitored. Once MH is diagnosed, dantrolene is the first choice. When without dantrolene, satisfactory outcome can be achieved through early diagnosis, timely removal of incentives, control of temperature, adequate oxygen supply, maintaining of stable internal environment, control of arrhythmia and protection of renal function.
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Objective To evaluate the injuries in Jiangyou Field Hospital first week after Wenchuan earthquake,and accumulate experience for better medical services and better-built field hospitals to meet the demands of the earthquake-stricken areas.Methods Classification was performed in 1 905 patients with emergency treatment.The medical records of those with hospital stay were retrospectively analysed,including geographical distribution,trauma type,diagnosis,initial treatment and outcomes.Results Six hundred and twenty-nine(33%)patients were hospitalized,with an average of 2 to 100 years old(median,41.2).Three hundred and eighty-four patients(61%)were admitted within the first three days after earthquake.The patients were mainly from Jiangyou City(245,39%),Beichuan County(194,31%)and Pingwu County (158,25%).The most common types of injuries were superficial lacerations(326,51.8%),fractures(202,32.1%) and soft tissue contusions/sprains(87,13.9%),among whom 15 experienced severe squeeze.There were 318 injuries to pelvis and extremities(50.6%),117 to head(18.6%)and 43 to back(6.8%),and 73 cases had multiple injuries (11.6%).Of 376 patients(59.8%)with operation,326 received debridement,21 external fixation,19 internal fixation, 11 amputation,4 laparotomy,4 fasciotomy and 2 craniotomy.The incidence of postoperative infections was 11.8%.Death occurred in 39 patients due to cerebral trauma,pelvic fracture,abdominal hemorrhage and multiple injuries.Conclusion When the earthquake has destroyed the major medical facilities,rapid organization of medical rescue teams,making full use of remaining medical resources and recovering electricity play an important role in the rescue of victims and reduction of mortality.Orthopaedic surgeons must dominate the medical teams as most of the earthquake victims suffer from injuries to the extremities.
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Objective:To summarize our experience on perioperative anesthesia management of patients with crush syndrome caused by earthquake under field condition.Methods:The clinical anesthesia data of 10 patients with crush syndrome caused by China Wenchuan earthquake,who were treated under field condition,were retrospectively analyzed,and our experience on perioperative anesthesia management was summarized.Results:After volume therapy,urine alkalization,and stabilization of internal environment,the 10 patients underwent dehridement,decompression by fasciotomy or amputation under epidural anesthesia or brachial plexus block plus psychological therapy and moderate tranquillizer.During the operation,the patients showed smooth respiratory and cardiovascular characteristics without pain.Conclusion:Under field condition,regional anesthesia can provide adequate analgesic effect during and after the surgery.Early fluid resuscitation and life support are vital to the safety and life of patients.