Anesthesiologists remind patients to fully communicate their genetic and allergy history before surgery. An 8-year-old boy may experience sudden malignant high fever during ophthalmic surgery, including Chuanchuan | systemic | medical staff
An 8-year-old boy named Chuanchuan experienced a sudden onset of malignant high fever during general anesthesia surgery on the morning of July 17th. His body temperature rapidly climbed to 39.1 degrees Celsius, carbon dioxide partial pressure rose to 71mmHg, blood potassium increased, and his muscles spasmed and stiffened throughout the body. Surgical anesthesiologists and a team from the Joint Anesthesiology Intensive Care Unit provided emergency rescue, turning the crisis into safety and successfully performing the surgery. Under close observation at SICU until the morning of the 18th, all monitoring indicators were stable and in good condition. In the afternoon, he was transferred to the ophthalmic general ward and was discharged this morning.
Chuanchuan suffered from severe congenital ptosis in both eyes, which affected his visual development and appearance. During the summer vacation, his parents took him from Hubei to Shanghai Ninth People's Hospital for treatment. The ophthalmology department arranged for the child to undergo surgery to correct the ptosis in both eyes.
On the morning of the 17th, the surgery proceeded as scheduled. However, during the surgery after general anesthesia, Liu Hua, the chief anesthesiologist and deputy chief physician of the anesthesia department, monitored a sudden and uncontrollable increase in the patient's end expiratory carbon dioxide, accompanied by unstable heart rate and blood pressure, as well as a significant increase in body temperature. He immediately became alert. Immediately conduct arterial blood gas analysis, turn off anesthesia inhalation gas, replace sodium lime, and replace all artificial airway pipelines. Report to the Deputy Director of Anesthesiology, Huang Yan, and the anesthesia nurse will be present immediately. At this moment, medical staff have discovered that the child has severe metabolic acidosis and hyperkalemia, with a temperature increase of 0.5 degrees within one minute and continuing to rise. The limbs muscles are stiff and there is a plate-shaped abdomen. Huang Yan immediately judged that it may be malignant high fever! The team quickly administered ice pack cold compress, ice saline lavage of the intestines and stomach, while high-dose hormone shock and alkaline urine were used to protect the kidneys. Close monitoring was carried out to prevent the discovery of hemolytic urine, and immediate hemodialysis treatment was needed to maintain the stability of vital signs.
A series of symptomatic treatments have shown significant effects. In a short period of time, the child's blood potassium and carbon dioxide partial pressure gradually decrease, and their body temperature also gradually drops. Under the escort of the anesthesia department and SICU team, a single intravenous general anesthesia method was adopted, and ophthalmologist Zhou Huifang completed the correction surgery for double eyelid ptosis in Chuanchuan. With the full support of the medical department, special drugs were transferred to emergency backup. After the surgery, Chuanchuan entered the SICU for further treatment and strict monitoring, and woke up at almost normal time to remove the catheter.
Huang Yan said, "At present, it can be confirmed that the child has hereditary genetic variation, and the incidence of malignant high fever related to it is 1/200000; from a professional perspective, malignant high fever is the highest risk of anesthesia complications, which may lead to severe cases such as systemic muscle lysis, renal failure, cardiac arrest and multiple organ failure, and the consequences are very serious." For this reason, experts remind that when seeing a doctor, it is necessary to fully communicate with the doctor before surgery, carefully recall and describe the past history, allergy history, family genetic history and other information, and jointly protect life and health.
