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Suspected Malignant Hyperthermia in a Strabismus Patient: A Case Report

Suspected Malignant Hyperthermia in a Strabismus Patient: A Case Report Abstract • Malignant hyperthermia is an autosomal dominant disorder with variable expressivity that is caused by a membrane defect in the sarcolemma of myofibrils. A patient with strabismus (esotropia) had tachycardia and masseter muscle rigidity on exposure to succinylcholine chloride and halothane, but because of rapid recognition of the condition and discontinuation of the procedure, the potentially lethal complications of malignant hyperthermia did not develop. A serum creatine phosphokinase level showed a substantial increase above normal. Two weeks later, the patient underwent successful correction of the strabismus under general anesthesia, using morphine sulfate and thiopental sodium without complication. This condition is of interest to ophthalmologists because it occurs with increasing frequency in patients with strabismus and ptosis, and it may be triggered by certain local anesthetic agents often used by ophthalmologists. References 1. Gibson CL, Johnson AB, Tuttle JP, et al: Heat stroke as a postoperative complication . JAMA 1900;35:883. 2. Moschcowitz AV: Post-operative heatstroke . Surg Gynecol Obstet 1916;23:443-451. 3. Guedel AE: Inhalation Anesthesia . New York, Macmillan Publishing Co Inc, 1937, pp 133-134. 4. Denborough MA: Current concepts of the etiology and treatment of malignant hyperthermia , in Aldrete JA, Britt BA (eds): Second International Symposium on Malignant Hyperthermia . New York, Grune & Stratton Inc, 1978, pp 537-544. 5. Denborough MA, Lovell RRH: Anesthetic deaths in a family . Lancet 1960;2:45.Crossref 6. Denborough MA, Forster JFA, Lovell RRH, et al: Anesthetic deaths in a family . Br J Anaesth 1962;34:395-396.Crossref 7. Ellis FR, Cain PA, Harriman DGF: Multifactorial inheritance of malignant hyperthermia susceptiblity , in Aldrete JA, Britt BA (eds): Second International Symposium on Malignant Hyperthermia . New York, Grune & Stratton Inc, 1978, pp 329-338. 8. Jardon OM, Wingard DW, Barak AJ, et al: Malignant hyperthermia: A potentially fatal syndrome in orthopaedic patients . J Bone Joint Surg Am 1979;61:1064-1070. 9. Britt BA: Etiology and pathophysiology of malignant hyperthermia . Fed Proc 1979;38:44-48. 10. Huckell VF, Staniloff HM, Britt BA, et al: Cardiac manifestations of malignant hyperthermia susceptibility . Circulation 1978;58:916-925.Crossref 11. Demeyere R: Malignant hyperthermia . Acta Anaesthesiol Belg 1978;29:101-120. 12. Denborough MA: Foreward , in Aldrete JA, Britt BA (eds): Second International Symposium on Malignant Hyperthermia . New York, Grune & Stratton Inc, 1978, p xi. 13. Blanck TJJ, Gruener R, Casey WJ, et al: Malignant hyperthermia . Ariz Med 1979;36:351-353. 14. Krakowiak FJ, Vatral JJ, Moore RC, et al: Malignant hyperthermia: Report of two cases . Oral Surg 1979;47:218-222.Crossref 15. Britt BA: Malignant hyperthermia: A pharmacogenetic disease of skeletal and cardiac muscle . N Engl J Med 1974;290:1140-1142.Crossref 16. Britt BA, Kalow W: Malignant hyperthermia: A statistical review . Can Anaesth Soc J 1970;17:293-315.Crossref 17. Haberman ML: Malignant hyperthermia: An allergic reaction to thioridazine therapy . Arch Intern Med 1978;138:800-801.Crossref 18. Beldavs J, Small V, Cooper DA, et al: Postoperative malignant hyperthermia: A case report . Can Anaesth Soc J 1971;18:202-212.Crossref 19. Barnes PK: Masseter spasm following intravenous suxamethonium . Br J Anaesth 1973;45:759-760.Crossref 20. Bergman JA: Idiopathic malignant hyperthermia: Review and report of a case . Arch Ophthalmol 1975;93:232-234.Crossref 21. Mathieu A, Bogosian AJ, Ryan JF, et al: Recrudescence after survival of an initial episode of malignant hyperthermia . Anesthesiology 1979;51:454-455.Crossref 22. Tammisto T, Brander P, Airaksinen MM, et al: Strabismus as a possible sign of latent muscular disease predisposing to suxamethonium-induced muscular injury . Ann Clin Res 1970;2:126-130. 23. Denborough MA, Forster JFA, Hudson MC, et al: Biochemical changes in malignant hyperpyrexia . Lancet 1970;2:1137-1138.Crossref 24. Britt BA, Endrenyi L, Peters PL, et al: Screening of malignant hyperthermia susceptible families by creatine phosphokinase measurement and other clinical investigations . Can Anaesth Soc J 1976;23:263-284.Crossref 25. Isaacs H: Comments on predictive tests for malignant hyperthermia , in Aldrete JA, Britt BA (eds): Second International Symposium on Malignant Hyperthermia . New York, Grune & Stratton Inc, 1978, pp 351-362. 26. Bronstein SL, Ryan DE, Solomons CC, et al: Dantrolene sodium in the management of patients at risk from malignant hyperthermia . J Oral Surg 1979;37:719-724. 27. Gatz EE, Wingard DW: Malignant hyperthermia . Nebr Med J 1973;58:434-437. 28. Bloom DA, Fonkalsrud EW, Reynolds RC: Malignant hyperpyrexia during anesthesia in childhood . J Pediatr Surg 1976;11:185-190.Crossref 29. Rowell RR: Malignant hyperthermia . Arch Ophthalmol 1971;85:638-639.Crossref 30. Beasley H: Hyperthermia associated with ophthalmic surgery . Am J Ophthalmol 1974;77:76-79. 31. Snow JC: Malignant hyperthermia during anesthesia and surgery . Arch Ophthalmol 1970;84:407-408.Crossref 32. Free CW, Jaimon MPC: Pre-anesthetic administration of dantrolene sodium to a patient at risk from malignant hyperthermia: Case report . NZ Med J 1978;88:493-494. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Ophthalmology American Medical Association

Suspected Malignant Hyperthermia in a Strabismus Patient: A Case Report

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Publisher
American Medical Association
Copyright
Copyright © 1981 American Medical Association. All Rights Reserved.
ISSN
0003-9950
eISSN
1538-3687
DOI
10.1001/archopht.1981.03930020121013
Publisher site
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Abstract

Abstract • Malignant hyperthermia is an autosomal dominant disorder with variable expressivity that is caused by a membrane defect in the sarcolemma of myofibrils. A patient with strabismus (esotropia) had tachycardia and masseter muscle rigidity on exposure to succinylcholine chloride and halothane, but because of rapid recognition of the condition and discontinuation of the procedure, the potentially lethal complications of malignant hyperthermia did not develop. A serum creatine phosphokinase level showed a substantial increase above normal. Two weeks later, the patient underwent successful correction of the strabismus under general anesthesia, using morphine sulfate and thiopental sodium without complication. This condition is of interest to ophthalmologists because it occurs with increasing frequency in patients with strabismus and ptosis, and it may be triggered by certain local anesthetic agents often used by ophthalmologists. References 1. Gibson CL, Johnson AB, Tuttle JP, et al: Heat stroke as a postoperative complication . JAMA 1900;35:883. 2. Moschcowitz AV: Post-operative heatstroke . Surg Gynecol Obstet 1916;23:443-451. 3. Guedel AE: Inhalation Anesthesia . New York, Macmillan Publishing Co Inc, 1937, pp 133-134. 4. Denborough MA: Current concepts of the etiology and treatment of malignant hyperthermia , in Aldrete JA, Britt BA (eds): Second International Symposium on Malignant Hyperthermia . New York, Grune & Stratton Inc, 1978, pp 537-544. 5. Denborough MA, Lovell RRH: Anesthetic deaths in a family . Lancet 1960;2:45.Crossref 6. Denborough MA, Forster JFA, Lovell RRH, et al: Anesthetic deaths in a family . Br J Anaesth 1962;34:395-396.Crossref 7. Ellis FR, Cain PA, Harriman DGF: Multifactorial inheritance of malignant hyperthermia susceptiblity , in Aldrete JA, Britt BA (eds): Second International Symposium on Malignant Hyperthermia . New York, Grune & Stratton Inc, 1978, pp 329-338. 8. Jardon OM, Wingard DW, Barak AJ, et al: Malignant hyperthermia: A potentially fatal syndrome in orthopaedic patients . J Bone Joint Surg Am 1979;61:1064-1070. 9. Britt BA: Etiology and pathophysiology of malignant hyperthermia . Fed Proc 1979;38:44-48. 10. Huckell VF, Staniloff HM, Britt BA, et al: Cardiac manifestations of malignant hyperthermia susceptibility . Circulation 1978;58:916-925.Crossref 11. Demeyere R: Malignant hyperthermia . Acta Anaesthesiol Belg 1978;29:101-120. 12. Denborough MA: Foreward , in Aldrete JA, Britt BA (eds): Second International Symposium on Malignant Hyperthermia . New York, Grune & Stratton Inc, 1978, p xi. 13. Blanck TJJ, Gruener R, Casey WJ, et al: Malignant hyperthermia . Ariz Med 1979;36:351-353. 14. Krakowiak FJ, Vatral JJ, Moore RC, et al: Malignant hyperthermia: Report of two cases . Oral Surg 1979;47:218-222.Crossref 15. Britt BA: Malignant hyperthermia: A pharmacogenetic disease of skeletal and cardiac muscle . N Engl J Med 1974;290:1140-1142.Crossref 16. Britt BA, Kalow W: Malignant hyperthermia: A statistical review . Can Anaesth Soc J 1970;17:293-315.Crossref 17. Haberman ML: Malignant hyperthermia: An allergic reaction to thioridazine therapy . Arch Intern Med 1978;138:800-801.Crossref 18. Beldavs J, Small V, Cooper DA, et al: Postoperative malignant hyperthermia: A case report . Can Anaesth Soc J 1971;18:202-212.Crossref 19. Barnes PK: Masseter spasm following intravenous suxamethonium . Br J Anaesth 1973;45:759-760.Crossref 20. Bergman JA: Idiopathic malignant hyperthermia: Review and report of a case . Arch Ophthalmol 1975;93:232-234.Crossref 21. Mathieu A, Bogosian AJ, Ryan JF, et al: Recrudescence after survival of an initial episode of malignant hyperthermia . Anesthesiology 1979;51:454-455.Crossref 22. Tammisto T, Brander P, Airaksinen MM, et al: Strabismus as a possible sign of latent muscular disease predisposing to suxamethonium-induced muscular injury . Ann Clin Res 1970;2:126-130. 23. Denborough MA, Forster JFA, Hudson MC, et al: Biochemical changes in malignant hyperpyrexia . Lancet 1970;2:1137-1138.Crossref 24. Britt BA, Endrenyi L, Peters PL, et al: Screening of malignant hyperthermia susceptible families by creatine phosphokinase measurement and other clinical investigations . Can Anaesth Soc J 1976;23:263-284.Crossref 25. Isaacs H: Comments on predictive tests for malignant hyperthermia , in Aldrete JA, Britt BA (eds): Second International Symposium on Malignant Hyperthermia . New York, Grune & Stratton Inc, 1978, pp 351-362. 26. Bronstein SL, Ryan DE, Solomons CC, et al: Dantrolene sodium in the management of patients at risk from malignant hyperthermia . J Oral Surg 1979;37:719-724. 27. Gatz EE, Wingard DW: Malignant hyperthermia . Nebr Med J 1973;58:434-437. 28. Bloom DA, Fonkalsrud EW, Reynolds RC: Malignant hyperpyrexia during anesthesia in childhood . J Pediatr Surg 1976;11:185-190.Crossref 29. Rowell RR: Malignant hyperthermia . Arch Ophthalmol 1971;85:638-639.Crossref 30. Beasley H: Hyperthermia associated with ophthalmic surgery . Am J Ophthalmol 1974;77:76-79. 31. Snow JC: Malignant hyperthermia during anesthesia and surgery . Arch Ophthalmol 1970;84:407-408.Crossref 32. Free CW, Jaimon MPC: Pre-anesthetic administration of dantrolene sodium to a patient at risk from malignant hyperthermia: Case report . NZ Med J 1978;88:493-494.

Journal

Archives of OphthalmologyAmerican Medical Association

Published: Jul 1, 1981

References