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Case
Two occurred in the operating room. The patient initially coughed on the endotracheal
tube. No generalized rigidity was noted. A tourniquet had been inflated in the leg <20
min when minute ventilation had to be increased to 3 times expected just to keep end-tidal
carbon dioxide (ETCO2) at 35 torr. Cardiovascular function was stable. There was no
obvious myoglobinuria. But the anesthesia providers suspected MH. The patient was cooled.
2 mg/kg of dantrolene was given. Bicarbonate and fluids were also given. ETCO2
became normal during normal minute ventilation. Post-operative creatine kinase, an enzyme
released from injured muscle, was 46,000 IU (normal <200iu). There was respiratory
muscle weakness that eventually resolved. The patient made a complete recovery and was
referred to MHAUS. Is this classic MH? |