CASE REPORTS Rhabdomyolysis Following Cardiopulmonary Bypass and Treatment with Enoximone in a Patient Susceptible to Malignant
Ⅵ CASE REPORTS Anesthesiology 2001; 94:355–7 © 2001 American Society of Anesthesiologists, Inc. Lippincott Williams & Wilkins, Inc. Rhabdomyolysis following Cardiopulmonary Bypass and Treatment with Enoximone in a Patient Susceptible to Malignant Hyperthermia Friedrich-Christian Riess, M.D.,* Marko Fiege, M.D.,† Sina Moshar, M.D.,‡ Heinz Bergmann, M.D.,§ Niels Bleese, M.D.,ʈ Joachim Kormann, M.D.,# Ralf Weißhorn, M.D.,† Frank Wappler, M.D.†† SEVERE hypercapnia, muscle rigidity, hyperthermia, and After implantation of a mechanical valve (Medtronic Hall; Medtronic, rhabdomyolysis characterize malignant hyperthermia Minneapolis, MN), the ascending aorta was closed and the aortic 1 cross-clamp removed. During reperfusion, the patient exhibited ST (MH) in fulminant form. However, during cardiac opera- Downloaded from http://pubs.asahq.org/anesthesiology/article-pdf/94/2/367/402332/0000542-200102000-00029.pdf by guest on 29 September 2021 elevations, with maximal values of 12 mV in all leads. The left ventricle tions using cardiopulmonary bypass (CPB), typical symp- appeared to be ischemic and hypokinetic. A triple bypass was per- toms of MH may not be present. We observed a patient formed using saphenous grafts to the left anterior descending, first undergoing aortic valve replacement, in whom severe post- diagonal branch and the circumflex artery. The patient was then operative rhabdomyolysis and arrhythmias developed after successfully weaned from CPB using a moderate dose of adrenalin (4 treatment with enoximone during CPB and cardioplegic g/min) and 50 mg enoximone (Perfan; Hoechst, Bad Soden am Ts., Germany). However, toward the completion of the operation, the arrest. Subsequently, in vitro contracture testing showed urine became dark and the minute ventilation necessary to maintain that the patient was susceptible to MH.
[Show full text]