PDF(Pubmed)
Abstract：
BACKGROUND: Malignant hyperthermia is a potentially lethal condition triggered by specific anesthetic drugs, especially a depolarizing muscle relaxant of succinylcholine (Suxamethonium). Despite the frequent use of succinylcholine with electroconvulsive therapy (ECT), there has been no reported case of potentially lethal malignant hyperthermia following ECT. In addition, the time interval between the administration of succinylcholine and the onset of malignant hyperthermia has not been outlined in the context of ECT.
METHODS: We present the case of a 79-year-old woman suffering from severe depression, who experienced severe malignant hyperthermia due to succinylcholine administration during an ECT session. She presented with a high fever of 40.2 °C, tachycardia of 140/min, hypertension with a blood pressure exceeding 200 mmHg, significant muscle rigidity, and impaired consciousness. These symptoms emerged two hours after ECT, which occurred in a psychiatric ward rather than an operating room, and reached their peak in less than 24 h. She was given 60 mg of dantrolene, which quickly reduced the muscular rigidity. Subsequently, she received two additional doses of 20 mg and 60 mg of dantrolene, which brought her fever down to 36.2 °C and completely eased her muscle rigidity within two days after ECT.
CONCLUSIONS: This is the first reported case of potentially lethal malignant hyperthermia after ECT. In addition, it highlights the delayed onset of malignant hyperthermia following an ECT procedure, emphasizing the necessity for psychiatrists to recognize its onset even after the treatment. In the light of potentially lethal consequences of malignant hyperthermia, it is critically important for psychiatrists to closely monitor both intraoperative and postoperative patient\'s vital signs and characteristic physical presentations, promptly identify any symptomatic emergence, and treat it immediately with dantrolene.
METHODS: We present the case of a 79-year-old woman suffering from severe depression, who experienced severe malignant hyperthermia due to succinylcholine administration during an ECT session. She presented with a high fever of 40.2 °C, tachycardia of 140/min, hypertension with a blood pressure exceeding 200 mmHg, significant muscle rigidity, and impaired consciousness. These symptoms emerged two hours after ECT, which occurred in a psychiatric ward rather than an operating room, and reached their peak in less than 24 h. She was given 60 mg of dantrolene, which quickly reduced the muscular rigidity. Subsequently, she received two additional doses of 20 mg and 60 mg of dantrolene, which brought her fever down to 36.2 °C and completely eased her muscle rigidity within two days after ECT.
CONCLUSIONS: This is the first reported case of potentially lethal malignant hyperthermia after ECT. In addition, it highlights the delayed onset of malignant hyperthermia following an ECT procedure, emphasizing the necessity for psychiatrists to recognize its onset even after the treatment. In the light of potentially lethal consequences of malignant hyperthermia, it is critically important for psychiatrists to closely monitor both intraoperative and postoperative patient\'s vital signs and characteristic physical presentations, promptly identify any symptomatic emergence, and treat it immediately with dantrolene.
摘要：
背景：恶性高热是由特定麻醉药物引发的潜在致命疾病，特别是琥珀酰胆碱（Suxamethonium）的去极化肌肉松弛剂。尽管经常使用琥珀酰胆碱与电惊厥治疗（ECT），目前还没有报道ECT后可能致命的恶性高热的病例.此外,在ECT的背景下，尚未概述琥珀酰胆碱给药与恶性高热发作之间的时间间隔。
方法：我们介绍了一个79岁女性患有严重抑郁症的案例，在ECT会话期间，由于琥珀酰胆碱的使用而经历了严重的恶性高热。她出现了40.2摄氏度的高烧，140/min的心动过速,血压超过200mmHg的高血压，显著的肌肉僵硬，和意识受损。这些症状在ECT后两小时出现，发生在精神病房而不是手术室，并在不到24小时内达到顶峰。她服用了60毫克丹曲林，这迅速降低了肌肉的刚性。随后，她接受了两剂20毫克和60毫克丹曲林，这使她的发烧降至36.2°C，并在ECT后两天内完全缓解了肌肉僵硬。
结论：这是首次报道的ECT后潜在致死性恶性高热的病例。此外,它突出了ECT手术后恶性高热的延迟发作，强调精神科医生即使在治疗后也要认识到其发病的必要性。鉴于恶性高热的潜在致命后果，它是至关重要的精神科医生密切监测术中和术后患者的生命体征和特征性的身体表现，及时识别任何症状的出现，并立即用丹曲林治疗。
方法：我们介绍了一个79岁女性患有严重抑郁症的案例，在ECT会话期间，由于琥珀酰胆碱的使用而经历了严重的恶性高热。她出现了40.2摄氏度的高烧，140/min的心动过速,血压超过200mmHg的高血压，显著的肌肉僵硬，和意识受损。这些症状在ECT后两小时出现，发生在精神病房而不是手术室，并在不到24小时内达到顶峰。她服用了60毫克丹曲林，这迅速降低了肌肉的刚性。随后，她接受了两剂20毫克和60毫克丹曲林，这使她的发烧降至36.2°C，并在ECT后两天内完全缓解了肌肉僵硬。
结论：这是首次报道的ECT后潜在致死性恶性高热的病例。此外,它突出了ECT手术后恶性高热的延迟发作，强调精神科医生即使在治疗后也要认识到其发病的必要性。鉴于恶性高热的潜在致命后果，它是至关重要的精神科医生密切监测术中和术后患者的生命体征和特征性的身体表现，及时识别任何症状的出现，并立即用丹曲林治疗。
