Die intraoperative Hyperpyrexie bei Osteogenesis imperfecta-Betroffenen

Abstract

The aim of this study was to evaluate the influence of different types of anesthesia upon the intra- and postoperative body temperature in osteogenesis imperfecta patients. The development of an intraoperative hyperpyrexia of unknown origin is a typical phenomenon in patients with osteogenesis imperfecta. Body temperatures of up to 40 degrees C are known to complicate the operation. Therefore, in a retrospective study, the pre-, intra- and postoperative body temperature curves of 45 operations under different anaesthesias were measured. Group A underwent a common balanced anaesthesia with the volatile anaesthetic Enfluran in combination with Fentanyl, while group B was operated on under total intravenous anaesthesia (TIVA) with Propofol and Alfentanil. The preoperative temperatures were not different in the two groups. The intraoperative curves showed a constant body core temperature or even an increase under Enfluran, while the temperature always decreased under TIVA. This could be confirmed by intraindividual studies in 5 patients.

Anesthesia considerations for patients with de Barsy syndrome

“…It is unknown if the hyperthermia was specific to this patient or whether other de Barsy syndrome patients may be affected, as in other congenital syndromes. Nonmalignant hyperthermia has been reported in other congenital syndromes such as osteogenesis imperfecta and Costello syndrome [14,15]. It has also been described in patients undergoing bidirectional Glenn procedures and protracted eye operations involving high atropinization [16,17].…”

Anaesthesia in children with osteogenesis imperfecta — report of 14 general anaesthetics in three children

“…More recent publications suggest that the hypermetabolic state and hyperthermia observed in OI during the perioperative period are not MH because they are self-limiting, muscle rigidity is not seen, and normocarbia is maintained. It is more likely that this phenomenon is a disorder of central thermoregulation, which can be triggered by various factors [2,9,12].…”

“…Fuerderer et al [12] reported 45 anaesthetics in 22 children with OI. In 27 procedures, balanced anaesthesia was administered using fentanyl and enflurane, while in 18 procedures, total intravenous anaesthesia (TIVA) was administered using propofol and alfentanil.…”

“…On the basis of these observations, the authors assumed that TIVA is a safer technique in children with OI [12].…”

Anästhesie zur Sectio caesarea bei einer Patientin mit Osteogenesis imperfecta

“…Unter Narkose kann es dann zu einem Hypermetabolismus kommen, der häufig mit schweren Komplikationen verbunden ist [9]. Auch hier könnten die volatilen Anästhetika eine Triggerfunktion besitzen [5]. Die Durchführung totaler intravenöser Anästhesien stellt heutzutage keinerlei Probleme mehr da, sodass generell empfohlen werden kann, triggerfreie Narkosen durchzuführen.…”