| Case Report of CABG Undergone
in a Patient with Malignant Hyperthermia Risk and AT III Deficiency |
(Department of Cardiovascular Surgery, Cardiac Center
Sakakibara Hospital, Okayama, Japan)
| Koki Nakamura |
Takato Hata |
Yoshimasa Tsushima |
| Mitsuaki Matsumoto |
Sohei Hamanaka |
Hidenori Yoshitaka |
| Genta Chikazawa |
Susumu Shinoura |
Satoru Otani |
|
Malignant hyperthermia (MH) and
antithrombin III (ATIII) deficiency are both rare, but once they
occur, the patient's prognosis is very poor. A67-year-old man
was referred to our hospital with a diagnosis of unstable angina.
A coronary angiography revealed stenosis of LMT and triple vessels.
The patient was considered a candidate for CABG. He had been
prescribed 50mg/day of dantrolene for frequent muscular convulsions
of the lower extremities. He had had a high CK level for a few
years. Therefore he was considered to be at high risk for malignant
hyperthermia (MH). He underwent CABG (×4). Dantrolene was administered
orally at a dose of 25mg and then 160mg intravenously before
anesthesia and modified NLA was performed in order to avoid probable
MH. During the operation, ATIII deficiency was suspected because
the reaction of ACT after heparinization was poor. ATIII preparation
(1,500 units) was used and CABG under cardiopulmonary bypass
was completed without any events. It was proved after the surgery
that the ATIII volume had been almost normal but its activity
had decreased. His postoperative course was good. For possibly
fatal MH and ATIII deficiency, it is necessary and important
to predict, prevent and diagnose as early as possible.
Jpn. J. Cardiovasc. Surg. 29: 268-271 (2000) |
|
