ABSTRACT
This clinical case report describes the use of extremely high doses of dantrolene in the management of an episode of malignant hyperthermia (MH). A 6-year-old, 25 kg girl underwent anesthetic induction with halothane for an elective inguinal herniorrhaphy. Tachydysrhythmias, laryngospasm, opisthotonos, rhabdomyolysis, and profound metabolic acidosis ensued as features of an MH crisis. Initial dantrolene administration did not alleviate the symptoms. Increasing doses of dantrolene eventually totaling 42 mg/kg, along with symptomatic supportive care, were administered successfully to treat the event. It is postulated that the severe muscle rigidity may have precluded the circulation of dantrolene to its site of action. The role of the Malignant Hyperthermia Association of the United States (MHAUS) Hotline as a 24-hour consultative service is noted.
Subject(s)
Dantrolene/therapeutic use , Malignant Hyperthermia/drug therapy , Anesthesia, Inhalation/adverse effects , Child , Dantrolene/administration & dosage , Female , Halothane/adverse effects , Humans , Isoflurane/adverse effects , Masseter Muscle/drug effects , Muscle Rigidity/chemically induced , Muscle Rigidity/drug therapy , Myoglobinuria/chemically induced , Myoglobinuria/drug therapy , Rhabdomyolysis/chemically induced , Rhabdomyolysis/drug therapyABSTRACT
The use of an indwelling catheter for repeated injections of local anesthetics has been a beneficial addition to our armamentarium for management of chronic pain syndromes. Indwelling catheters take advantage of anatomic planes, and the concept of an interabdomins muscular plane allows placement of a catheter along the course of the ilioinguinal and iliohypogastric nerves. We report the successful treatment of chronic groin pain via an interabdominis indwelling catheter. This is the first report of the use of such an indwelling catheter.
