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Canadian Journal of Anesthesia, Vol 16, 106-112, Copyright © 1969 by Canadian Anesthesiologists' Society

Malignant Hypertonic Hyperpyrexia Syndrome

JAMES A. GIBSON B.SC., M.D., CM.1 and DOUGLAS M. GARDINER M.B., CH.B.1

1 Department of Anaesthesia, St. Mary's Hospital, New Westminster, British Columbia

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 hyperpyrexia; 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.






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Copyright © 1969 by the Canadian Anesthesiologists' Society.