Supraventricular tachycardia following second induction of anesthesia in a patient diagnosed as malignant hyperthermia after first anesthetic exposure: terminology requires a second look

A 17 year old male who underwent surgery for thoracic outlet syndrome developed a postoperative complication which was labelled and diagnosed as malignant hyperthermia in Kerman Medical Center. The temperature recorded was 43°C, Pa CO[2] 70 mmHg and serum potassium level was 7 mEq/L. The patient was hospitalized in the intensive care unit for 10 days. On discharge, the patient had aphasia and in coordination in gait. Gradually the symptoms improved. However dysarthria, a reduction in muscle force and a staggering gait persisted. The same patient underwent a second operation for a spinal cord tumor located in the cervical region at this center. Following induction of anesthesia, the pulse rate showed a stepladder rise reaching a peak of 198 per minute. Except for a rapid heart rate, the patient had an uneventful operative course and a speedy recovery following the operation without any sequelae. The case is being reviewed and the plethora of diverse symptomatology and clinical picture explored to highlight the controversy of malignant hyperthermia in this particular case

Dystonic movements following thalamonal and alfentanil induction

A 62 year old woman developed dystonic movements following induction of anesthesia with thalamonal and alfentanil. The patient remained awake during the episode. A small dose of thiopental sodium followed by succinylcholine aborted the unpleasant state. The case is being presented to emphasize the point that even small doses of opioid narcotic can cause tonic movements and frank seizures in some patients

Relationship between succinylcholine-induced apnea and dibucaine number in patients with genetic deficiency of plasma cholinesterase

In this study, a commercially available kit in which propionylthiocholine is used as a substrate and a dibucaine solution to determine the variants of the enzyme were utilized. Plasma cholinesterase activity of 151 patients who underwent different operations was measured during a period of six months. The mean +/- SD of the enzyme activity in 150 patients was 4.39 +/- 1.17 kU/L. Seventeen patients [11.2%] were found to have a serum cholinesterase activity of less than normal [<3 kU/L], but the period of apnea and the dibucaine number [DN] were found to be normal. Eight patients [5.3%] displayed an increased sensitivity to succinylcholine. Six of these patients [4%] were heterozygous for atypical enzyme with a mean period of apnea of 18.6 min [range 12-35 minutes] and had a dibucaine number of less than normal [<80%]. The DN of the other two patients [1.3%] who were homozygotes and had an exceedingly low atypical enzyme allele was 10% and 24%. The mean +/- SD DN value, in the 149 out of 151 patients was 84.41 +/- 2.91%, and the DN ranged from 10-90% in these patients. The mean +/- SD apnea period in the 149 patients was 6.37 +/- 4.28 min

Reconstructive surgery for hypertelorism and its anesthetic management

The indigent patient in whom induced hypotension has been produced by means of chlorpromazine needs a close surveillance and not the type of nonconventional management that some pursue. Proper and adequate monitoring of the patient is warranted at every step to dispel the concern and anxiety of residents and anesthesiologists not acquainted and abreast with chlorpromazine induced hypotension. In short we can equivocally state that the technique is highly rewarding in operations where blood loss is imminent and life threatening