척추마취후 발생한 전신적 근강직 , 고열 , 의식소실 및 자율신경기능부전 임상 2 예

Malignant hyperthermia is a fulminant hypermetabolic state of skeletal muscle induced by volatile inhalation anesthetics, succinylcholine, stress, exercise and etc. The primary signs of this disease included tachycardia, tachypnea, fever, generalized rigidity, metabolic and respiratory acidosis, central venous desaturation and hypercarbia as well as increasing endtidal CO₂ .Malignant hyperthermia is an utosomal dominant trait in human and quite different from the recessive trait in pig. There were some clinical reports that malignant hyperthermia can occur occasionally during and after spinal anesthesia. Now we also experienced two cases of generalized muscular rigidity, hyperpyrexia, tachycardia, hypotension, cardiae arrhythmia and slightly metabolic acidosis during and after spinal anesthesia. Those signs were very similar to malignant hyperthermia. And the two patients and someone among the family showed increased serum creatine kinase. There was no serum electrolyte imbalance such as natrium, ionized calcium and magnesium. And function tests of thyroid and parathyroid, electroencephalogram and brain computed tomogram were all within normal limit. So we suspected and concluded that it should be malignant hyperthermia. But we could not confirm that malignant hyperthermia, because of not doing halothane caffeine contracture test due to a lack of equipment in our hospital.