Summary
Two cases of a malignant hypertonic cyanotic hyperpyrexic syndrome which terminated in death are presented. Succinylcholine is suggested as the trigger mechanism in each case. Common diagnostic features were: (1) hypertonia, including (a) jaw stiffness and (b) subsequent intensive generalized muscle spasm; (2) cyanosis with an accompanying myoglobinuria; (3) malignant hyper-pyrexia; and (4) hyperkalaemia. Abnormal jaw stiffness was evident following the use of succinylcholine. This appeared before the patient received halothane.
The results of treatment are discouraging. Cooling seems to be an urgent necessity and should be rigorous from the outset. Dangerous hyperkalaemia may be lessened by intravenous calcium gluconate and peritoneal dialysis. A possible association between myoglobinuric myopathy (McArdle’s Disease) and this syndrome is suggested.
RéSUMé
Nous présentons deux cas du syndrome d’hyperpyrexie avec cyanose et hypertonie, cas qui se sont terminés par la mort. Dans chaque cas, la succinylcholine semble être le facteur déclenchant du mécanisme. Les facteurs communs pour le diagnostic sont:
-
1.
l’hypertonie (a) raideur du maxillaire et (b) par la suite des spasmes musculaires intensifs généralisés;
-
2.
une cyanose accompagnée de myoglobinurie;
-
3.
une hyperpyrexie maligne;
-
4.
une hyperkalihémie.
Aprés l’administration de la succinylcholine, nous avons noté une raideur du maxillaire et cela avant que le malade ne reçoive d’halothane.
Les résultats du traitement sont décourageants. Il semble de toute nécessité qu’il faille refroidir et, cela, dès le début et de façon vigoureuse. On peut diminuer l’hyperkalihémie dangereuse en administrant du gluconate de calcium par voie endoveineuse et faire une dialyse péritonéale. Ce syndrome nous fait penser à une certain association avec une myopathie (maladie de McArdle) à cause de la myoglobinurie.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Patterson, I. S. Generalized Myotonia Following Suxamethonium: A Case Report. Brit. J. Anaesth.34: 340 (1962).
Davies, L. E. &Graves, H. B. Hyperpyrexia and Death Associated with General Anaesthesia. Canad. Anaesth. Soc. J.13: 447 (1966).
Relton, J. E. S.;Creighton, R. E.;Johnston, A. E.;Pelton, D. A.; &Conn, A. W. Hyperpyrexia in Association with General Anaesthesia in Children. Canad. Anaesth. Soc. J.13: 419 (1966).
Thut, W. H. &Davenport, H. T. Hyperpyrexia Associated with Succinylcholineinduced Muscle Rigidity: A Case Report. Canad. Anaesth. Soc. J.13: 425 (1966).
Cullen, W. G. Malignant Hyperpyrexia during General Anaesthesia: A Report of Two Cases. Canad. Anaesth. Soc. J.13: 437 (1966).
Thiel, R. E. The Myotonic Response to Suxamethonium. Brit. J. Anaesth. 39: 815 (1967).
Purkis, I. E.;Horrelt, O.;Young, C. G.;Fleming, R. A. P.; &Langley, G. R. Hyper-pyrexia during Anaesthesia in a Second Member of a Family with Associated Coagulation Defect Due to Increased Intravascular Coagulation. Canad. Anaesth. Soc. J.14: 183 (1967).
Lavoie, G. Hyperpyrexia during General Anaesthesia: A Case Report. Canad. Anaesth. Soc. J.13: 444 (1966).
Relton, J. E. S.;Creighton, R. E.;Conn, A. W.; &Nabeta, S. Generalized Muscular Hypertonicity Associated with General Anaesthetic Management. Canad. Anaesth. Soc. J.14: 22 (1967).
Cody, J. R. Muscle Rigidity Following Administration of Succinylcholine. Anesthesiology.29: 159 (1968).
Jensen, K.;Bennike, H. K.;Hanel, H. K.; &Olesen, H. Myoglobinuria Following Anaesthesia Including Suxamethonium. Brit. J. Anaesth.40: 329 (1968).
Foster, N. E. Personal communication: report of a death associated with hyperpyrexia and hypertonia (1968).
Airaksinen, M. M. &Tammisto, T. Myoglobinuria after Intermittent Administration of Succinylcholine during Halothane Anaesthesia. Clin. Pharmacol. Therap.7: 583 (1966).
Smith, R. M. Anaesthesia for Infants and Children. Third ed., Saint Louis: C. V. Mosby (1968).
Britt, B. A. &Kalow, W. Hyper-rigidity and Hyperthermia Associated with Anaesthesia. Ann. N.Y. Acad. Sc.151: 947 (1968).
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Gibson, J.A., Gardiner, D.M. Malignant hypertonic hyperpyrexia syndrome. Can. Anaes. Soc. J. 16, 106–112 (1969). https://doi.org/10.1007/BF03005790
Issue Date:
DOI: https://doi.org/10.1007/BF03005790