[Case of suspected malignant hyperthermia following local infiltration anesthesia].

A 49-year-old man with no past history of malignant hyperthermia (MH) and scheduled for hernia repair was suspected of MH after local infiltration anesthesia at other hospital. Although intravenous diazepam was not effective for increased body temperature, tachycardia, and convulsion, dantrolene was effective for these signs. However, blood test showed no abnormal finding. At our hospital, he was scheduled for hernia repair and muscle biopsy under total intravenous anesthesia. No event occurred intra- and postoperatively. The examination for muscle biopsy revealed that the function of his ryanodine receptor 1 is abnormal. The events which had occurred at other hospital were uncertain of being associated with MH.

[TURP syndrome with severe hyponatremia (98 mEq x l(-1)): a report of a case].

We report a case of transurethral resection of prostate (TURP) syndrome with severe hyponatremia (98 mEq x l(-1)). A relatively healthy 71-year-old man (167 cm and 61 kg) with benign prostatic hypertrophy was scheduled for transurethral resection of the prostate under general anesthesia. Ninety minutes after starting the operation, electrolyte analysis revealed a decrease in serum Na concentration (Na 98 mEq x l(-1), BE -6.4), and 7% NaHCO3 60 ml + saline 500 ml were rapidly administered, and saline 500 ml + 10% NaCl 60 ml were administered at a rate of 100 ml per hour (Na 32 mEq x hr(-1)). One hour later, serum Na concentration was 111 mEq x l(-1). No ECG changes were observed during TURP. No neurological signs were observed, postoperatively. Central pontine myelinolysis (CPM) has been associated with excessively rapid correction of chronic hyponatremia. However, the pathophysiology of chronic hyponatremia is different from that of acute hyponatremia. Central pontine myelinolysis has not yet been reported after correction of acute hyponatremia in the TURP patient. Acute hyponatremia during TURP should be corrected rapidly, because acute hyponatremia can cause neurological complications.

[Effect of amino acid infusion for prevention of intraoperative hypothermia during laparotomy].

BACKGROUND: Amino acid infusion prevents intraoperative hypothermia. The purpose of this study is to examine the effect of amino acid infusion on intraoperative core temperature of patients during laparotomy. METHODS: Forty-two patients (duration of surgery of 180 min or more) and 32 patients (duration of surgery less than 180 min) scheduled for open gastrectomy under sevoflurane anesthesia combined with epidural anesthesia were randomly allocated to receive either amino acid solution (A group) or electrolyte solution (S group) intravenously. Each solution was started at anesthesia induction. The levels of tympanic temperature were recorded after induction, during surgery and at extubation. RESULTS: Patients in each of the two groups (A group vs. S group) were comparable with their characteristics and anesthetic management. Amino acid infusion prevented intraoperative hypothermia for cases of 180 min or more. The number of patients with temperature of less than 35.5 degrees C in A group was less those that in S group for cases shorter than 180 min. CONCLUSIONS: Amino acid infusion has more preventive effect on intraoperative hypothermia than electrolyte solution.