Whole Body Hyperthermia in Treatment of 39 Cases of Advanced Hepatic Carcinoma / 中国普外基础与临床杂志

Objective To evaluate the efficacy of whole body hyperthermia(WBH) in the treatment of advanced hepatic carcinoma and its effect on liver function.Methods From 2001 to 2004,39 cases of advanced hepatic carcinoma were treated with WBH.The effect of WBH on liver function was assessed by liver function test before and after treatment.Results ①The effective rate of WBH was 61.5%(24/39) in the treatment of advanced hepatic carcinoma with declined AFP in 60.0%(9/15) of patient and 100% of patients had pain relieve.The survival rates of 6 months,1 year and 2 years were 76.9%(30/39),59.0%(23/39) and 12.8%(5/39),respectively.②Alanine aminotransferase(ALT) elevated obviously in 1-3 d after treatment(P

Malignant Hyperthermia during General Anesthesia and Anesthetic Management for That Same Patient in Day Surgery Center: A case report / 대한마취과학회지

Malignant hyperthermia is a potentially fatal hypermetabolic syndrome characterized by hyperpyrexia and skeletal muscle rigidity. We experienced a case of malignant hyperthermia after general anesthesia with halothane and succinylcholine in day surgery center. 2 years old male patient arrived to get congenital ptosis operation. He was relatively healthy and had no considerable past or family history of hereditary disease. Anesthesia induced with halothane inhalation and succinylcholine. After induction, he abruptly showed masseter muscle rigidity, total body rigidity, elevation of end-tidal CO2 tension, tachycardia and hyperthermia. Under the suspicion of malignant hyperthermia, all anesthetics were discontinued and vigorous emergency treatment was attemped with dantrolene sodium. The patient survived without any sequele and discharged after 11 days. About 10 months later, that same patient comes to our hospital to take the operation. We experienced successful anesthetic management for malignant hyperthermia.

notropic and Electrophysiologic Effect of Azumolene in Intact Myocardium In Vitro / 대한마취과학회지

BACKGROUND: The effects of various concentrations (10, 25 micrometer) of azumolene, an analogue of dantrolene, were studied in isolated guinea pig ventricular papillary muscles by measuring the effects on myocardial contractility and electrophysiologic parameters. METHODS: Isometric forces were studied in normal and 26 mM K Tyrode's solution. Rapid cooling contracture, an index of SR Ca2 content, was performed. Normal and slow action potentials (APs) were evaluated by using conventional microelectrode technique. RESULTS: Ten and 25 micrometer azumolene depressed peak force and maximum rate of force development ( 30 40%). Dose-dependent depression was shown at 2 and 3 Hz stimulation rate. Rapid cooling contractures following 10 and 25 micrometer azumolene was not altered compared to control while peak force at 2 Hz stimulation rate just prior to cooling was depressed similarly to normal Tyrode's solution. In 26 mM K Tyrode's solution, 10 and 25 micrometer azumolene caused depression of early (10 micrometer: 20%) and late (10 micrometer: 50%) force development. In slow APs, shortening of AP duration at 20, 50, and 90% of the repolarization phase, as well as a small but significant reduction of dV/dt-max ( 20%) were shown at 0.25 Hz stimulation rate. There was no alteration in AP parameters in normal APs. CONCLUSIONS: The direct myocardial depressant action of azumolene seems to be at least in part caused by inhibition of Ca2 influx via the Ca2 channel in sarcolemma. It seems likely that azumolene does not alter the sarcoplasmic reticulum function such as Ca2 uptake and release in cardiac muscle.

Analysis of Reported Cases of Malignant Hyperthermia in Korea / 대한마취과학회지

BACKGROUND: Malignant hyperthermia (MH) is a hypermetabolic disorder of skeletal muscle that manifests after exposure to triggering episodes such as halothane or succinylcholine. The first case was reported in Australia on 1960 by Denborough. In Korea the first case report was made by Lim on 1971. The authors retrospectively analysed the reported cases of MH and/or masseter muscle rigidity in Korea for the establishment of appropriate diagnostic criteria and rapid treatment. METHODS: Twenty-one cases of MH and 2 cases of masseter muscle rigidity were analysed retrospectively form 1971 to 1995. These cases were reported in Journal of Korea Society of Anesthesiology and Journal of Research Institute of Medical Science of Korea. The analyzed items were age, department, anesthesia, symptoms and signs, drugs for treatment, history of patient and family and prognosis of MH. RESULTS: The incidence of MH was higher in male patients below the 4th decade of life. The rate was 0.6 per year from 1971 to 1995. In nineteen patients, inhalation anesthetics with succinylcholine were suspected as triggering agents and 4 patients' conditions were related to spinal anesthesia by tetracaine. Only one case of MH occured within 10 min. after induction, but 22 cases occured during operations or the recovery period, and one case in the ward. The most common initial signs were muscle rigidity, high fever with arrhythmia and increased blood pressure. Related laboratory findings were acidosis, elevated end tidal CO2, and hyperkalemia. Six cases had family histories or past histories related to MH. CONCLUSIONS: The incidence of MH is progressively increasing in Korea. But MH will be prevented and treated effctively. So we should prepare a monitoring system for early detection and a supply of dantrolene for treatment. These precautions will spread nationwide and will need the support of the anesthesiology society and the goverment.

Suspicious Malignant Hyperthermia in Child during General Anesthesia: A case report / 대한마취과학회지

We had a 16-month-old male presented for a surgery for degloving injury of left lower extremity. He had no considerable past or family history. High fever and increased end-tidal CO2 with tachycardia was revealed after induction of general anesthesia with thiopental sodium, vecuronium, isoflurane-N2O and O2. Arterial blood gas analysis showed a severe mixed acidosis. Under the suspicion of malignant hyperthermia, all anesthetics were discontinued. Anesthesia was maintained with fentanyl and midazolam. The patient was managed with surface cooling, gastric lavage with cold saline, sodium bicarbonate and diuretics. Dantrolene sodium 50 mg was administered. The patient survived without any sequelae and discharged after 9 days. The etiologic factors, incidence, clinical features, prevention and treatments of malignant hyperthermia are discussed.