Patient with a history of ?malignant hyperpyrexia (Case discussion)
本帖最后由 shenxiu2 于 2010-2-4 14:49 编辑48 year old , male .
Came in for toilet & suturing of multiplelaceration wounds of right hand & fingers.
No history of medical illness. Previous anesthesia 11 years ago for Appendicectomy . He " collapsed " in recovery room about one hour after the surgery .Blood test : blood counts, renal function test, ECGwere normal .
Further questioning regarding the meaning of the word "collapse" revealed that :he became restless, havingdifficulty in breathing ,and then lost consciousness after that, he was resuscitated, put on ventilator , sent to ICU . He was in ICU for 2 weeks , and was discharged well . The doctors did many tests, and he was told one month later that he is "allergic" to anesthetic drugs .
The patient was not able to give any more details other than these mentioned.
1. How wouldyou manage this patient?
2. What do you think he had 11 years ago? 1. How wouldyou manage this patient?
1)I will suggest brachial plexus anesthesia or general anasthesia with laryngeal mask for him.
2) Be prepared for crisis mangemnet, the "crisis" should include allergic shock, malignant hyperthermia, asthma, acute pulmonary edema.
2. What do you think he had 11 years ago?
I am not sure. Of course,allergic shock might be in the first place according to the history he had given to us, thoughthe chance of long stay( 2 weeks) in ICU is raraly for allergic shock. Delay finding and delay treatment for airway problems after extubationmight be in the second place.As for MH, Ithink the doctor should have given his detail informations to him or his close relatives if he did collaps for MH 11 years ago. Thank you for your opinion . I do agree with you.
If we are going to use Laryngeal mask , I would think it is safer to use Total intravenous anesthesia.
What do you think?
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