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S U R G I C A L
E M E R G E N C I E S
doses of dantrolene are required to bring the episode under control in
the OR and to combat intermittent hyperthermia, acidosis and elevated
creatine kinase levels (a sign of muscle breakdown) in recovery. In an
attempt to stabilize the patient, they administered another 2.5mg/kg of
dantrolene, then another 1mg/kg, but muscle rigidity persisted, as did
the acidosis and the elevated potassium.
The OR team — which, because the crisis had occurred midday,
included several anesthesia providers, surgeons and nurses — was controlling the elevated CO2 and hyperthermia, but muscle rigidity and acidosis continued. They gave additional dantrolene as 2.5mg/kg boluses
or greater. There was a brief reduction in muscle rigidity, but it never
resolved. What's more, the patient intermittently developed ventricular
arrhythmias. For all intents and purposes, he was experiencing cardiac
arrest. The team began CPR using full-scale, advanced, cardiac life support drugs.
Almost the entire supply of dantrolene had been given when MH's
deadliest consequences came calling. Collapsing heart function manifested as pulmonary edema, with bloody secretions emerging from the
endotracheal tube. Failing organs led to a failure of the coagulation
system, as evidenced by internal bleeding from various organs and
skin puncture sites. No matter what the team did — and they'd followed every guideline and recommendation — this unfortunate patient
was not responding. The rigidity continued, and to the shock and disbelief of the team, the patient's heart completely failed.
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