Malignant Hyperthermia during Thoracoscopic Pulmorrhaphy in a 70-Year-Old Man

Malignant hyperthermia (MH) is a rare but potentially fatal complication that may develop under general anesthesia (GA) and is rarely reported in elderly patients. We encountered a case of mild-onset MH in a 70-year-old patient who was receiving an elective thoracoscopic pulmorrhaphy and had a history of several GA procedures. Anesthesia was induced with propofol, fentanyl, and rocuronium and maintained with sevoflurane and remifentanil. His body temperature (BT) was 37.9°C after induction. During the procedure, the end-tidal CO2(ETCO2) increased steadily to 47–50 mmHg, presumably in response to the single lung ventilation. At the end, BT was 38.1°C and ETCO2was 47 mmHg under spontaneous breathing. After extubation, the patient wheezed on inspiration and expiration, and his trachea was reintubated. Sixty minutes after surgery, BT increased to 40.5°C and the arterial blood gas analysis showed severe metabolic acidosis. Based on these findings, MH was suspected and a bolus dose of dantrolene was administered. He responded to the dantrolene, and no complications or recurrence of MH was observed postoperatively. In this patient, the initial signs of MH were so subtle that making the diagnosis of MH was difficult. A high degree of suspicion is necessary to prevent a fulminant MH crisis.

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Electrocardiographic features of hyperkalemia during acute kidney injury in a patient with pacemaker

Italian Journal of Medicine ◽

10.4081/itjm.2018.986 ◽

2018 ◽

Vol 12 (2) ◽

pp. 145

Author(s):

Alfonso Sforza ◽

Federica De Pisapia ◽

Giuliano De Stefano ◽

Antonio Gaspardini ◽

Maria Immacolata Arnone ◽

...

Keyword(s):

Cardiac Activity ◽

Kidney Injury ◽

Blood Gas Analysis ◽

Sine Wave ◽

Gas Analysis ◽

Acute Confusional State ◽

Arterial Blood Gas ◽

Arterial Blood ◽

Arterial Blood Gas Analysis ◽

History Of

We describe a case of a 79-year-old man with pacemaker who presented to the Emergency Department due to asthenia and acute confusional state. He had a history of atrial fibrillation, anemia and colostomy and he was on treatment with diuretics. The electrocardiogram (ECG) showed pacemaker-induced ventricular activity, QRS complexes excessively wide with sine-wave appearance, tall and peaked T waves, without electrically evident atrial activity. Potassium concentration on arterial blood gas analysis was 8.8 mmol/L. ECG abnormalities disappeared after therapy with calcium chloride and spontaneous cardiac activity reappeared.

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Respiratory monitoring: Arterial blood gas analysis, pulse oximetry, and end-tidal carbon dioxide analysis

Clinical Techniques in Small Animal Practice ◽

10.1016/s1096-2867(99)80015-2 ◽

1999 ◽

Vol 14 (4) ◽

pp. 227-230 ◽

Cited By ~ 21

Author(s):

Jeffrey Proulx

Keyword(s):

Carbon Dioxide ◽

Blood Gas Analysis ◽

Gas Analysis ◽

Blood Gas ◽

Arterial Blood Gas ◽

Arterial Blood ◽

Arterial Blood Gas Analysis ◽

End Tidal Carbon Dioxide ◽

Carbon Dioxide Analysis ◽

End Tidal

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Capnography in Critical Care Medicine

Journal of Intensive Care Medicine ◽

10.1177/088506669701200103 ◽

1997 ◽

Vol 12 (1) ◽

pp. 18-32

Author(s):

Eugene Y. Cheng ◽

Harvey Woehlck ◽

Anthony J. Mazzeo

Keyword(s):

Blood Gas Analysis ◽

Gas Analysis ◽

Infrared Spectrometry ◽

Wave Form ◽

Positive End Expiratory Pressure ◽

Arterial Blood Gas ◽

Arterial Blood ◽

Arterial Blood Gas Analysis ◽

Noninvasive Monitor ◽

End Tidal

Capnography is a noninvasive method of monitoring exhaled CO2 and is used in many situations as a reflection of arterial CO2 concentration. Expired CO2 can be accurately measured using infrared spectrometry, mass spectrometry, and Raman scattering. Colorimetric CO2 detectors are useful as a qualitive indicator of the presence of CO2. Trending end-tidal CO2 and analysis of the capnographic wave form can provide information on changes in a patient's cardiopulmonary status or malfunction of equipment used to support a patient's cardiovascular or pulmonary systems. The accuracy of end-tidal CO2 measurements as a reflection of arterial CO2 tension in critically ill patients with respiratory or cardiovascular problems is limited. Changes in deadspace, respiratory rate and depth, positive end-expiratory pressure, areolar circulation, and cardiac output can significantly impact end-tidal CO2 values more than arterial CO2 concentrations. With marked changes in end-tidal CO2 that are of concern, arterial blood gas analysis should be obtained to determine if the end-tidal CO2 measurement is representatire of a change in arterial CO2 concentrations. Despite the limitations of end-tidal CO2 as a reflection of arterial CO2, it is still useful as a noninvasive monitor to alert clinicians of potential changes in a patient's cardiopulmonary condition.

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