A review of the materials in the current issue regarding malignant hyperthermia caused this editor to reflect on the past and retrieve the following case study and comments from the archives of the NEWSLETTER.

"A 15-month-old child underwent closure of a cleft palate under endotracheal cyclopropane, nitrous oxide, oxygen-ether anesthesia. Five hours later, hyperthermia developed, followed by death two hours and 10 minutes later."

Comments were sent in by readers. Some of their commentaries included the following "observations":

• "There is certainly nothing in the protocol to suggest any major lapse in anesthetic management. One might be a 'nit-picker' over the use of the Y-tube, instead of an absorption method with assisted respiration. The long and successful use of the Y or T-tube method is above serious reproach."
• "The causes of this accident can be defined, but why it happened cannot be as specifically delineated, although a reasonable general hypothesis may be made. That it happened at all is an indictment of the anesthetic management, although the anesthesiologist concerned could not, in all sincerity, diagnose his error."
• "A child of this age has a poorly developed, easily upset temperature regulating center. We know that her hypothalamus was injured either directly by hypoxia or secondary to a change in intracranial pressure. At this age, the hypothalamus is very sensitive to such alterations in intracranial pressure."
• "The cerebral edema is most likely due to hypoxia (although it could be the result of hypercarbia). Somewhere in the seemingly well-conducted anesthesia this occurred. We can only speculate which of the numerous 'whys' was at fault."

Temperature management plagued earlier anesthesiologists in an era absent of continuous temperature-recording capabilities. Furthermore, intubations were usually carried out with straight ether or cyclopropane anesthesia in children. Succinylcholine was not commonly used for children in the Editor's experience.

There will be two more articles in upcoming issues of the NEWSLETTER on the clinical presentation of malignant hyperthermia by Richard Kaplan, M.D., and on the epidemology of malignant hyperthermia, co-authored by Steven M. Karan, M.D. and Carolyn P. Greenberg, M.D.

Erwin Lear, M.D.
Editor

return to top

FEATURES

Malignant Hyperthermia: An Issue to Explore

• Malignant Hyperthermia 1997: Looking to the Future
  
  
• MHAUS: Educating Providers, Patients and Public About an Uncommon Disorder
  
  
• Current Diagnostic Testing for MH
  
  
• Malignant Hyperthermia ­ Prevention and Treatment
  
  
• North American Malignant Hyperthermia Registry Clinical and Research Mission
  
  

ARTICLES

• 'Fen/Phen' and Anesthesia ­Fact, Fiction and Other Concerns
  
  
• Events That Shaped a City of Mystique ­ San Diego
  
  
• Plans Under Way for 1997 ASA Annual Meeting in San Diego
  
  
• Practice Options:The Anesthesiologist as a Consultant
  
  
• Practice Options: Solo, Group, Academic Modes of Practice
  
  
• Apgar Stamp Available Again
  
  
• ASA Publishes 1997 Manual for Anesthesia Department Organization and Management...

DEPARTMENTS

• To the Membership
• President's Page
  
• Washington Report
  
• Practice Management
  
• Residents' Review
• ASA News
• In Memoriam
• Letters to the Editor
• FAER Report
  

The views expressed herein are those of the authors and do not necessarily represent or reflect the views, policies or actions of the American Society of Anesthesiologists.

NL Archives

Information for Authors