Susceptibilidade à hipertermia maligna em três pacientes com síndrome maligna por neurolépticos

Silva, Helga Cristina Almeida da; Bahia, Valéria Santoro; Oliveira, Rogério A. A.; Marchiori, Paulo Eurípedes; Scaff, Milberto; Tsanaclis, Ana Maria Crous

doi:10.1590/s0004-282x2000000400018

Cited by 9 publications

(16 citation statements)

References 25 publications

(29 reference statements)

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“…[1][2][3][4] Respiratory failure secondary to muscle rigidity, and aspiration and pulmonary embolism have been described. 5, 6 A case of acute respiratory distress syndrome associated with neuroleptic drug administration, with concomitant neuroleptic malignant syndrome, is reported.…”

Section: Introductionmentioning

confidence: 99%

Neuroleptic-induced acute respiratory distress syndrome

2003

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A 41-year-old man presented right otalgia and peripheral facial paralysis. A computed tomography scan of the skull showed a hyperdense area, 2 cm in diameter, in the pathway of the anterior intercommunicating cerebral artery. Preoperative examination revealed: pH 7.4, PaCO2 40 torr, PaO2 80 torr (room air), Hb 13.8 g/dl, blood urea nitrogen 3.2 mmol/l, and creatinine 90 mmol/l. The chest x-ray was normal. The patient had not eaten during the 12-hour period prior to anesthesia induction. Intravenous halothane, fentanyl 0.5 mg and droperidol 25 mg were used for anesthesia. After the first six hours, the PaO2 was 65 torr (normal PaCO2) with FiO2 50% (PaO2/FiO2 130), and remained at this level until the end of the operation 4 hours later, maintaining PaCO2 at 35 torr. A thrombosed aneurysm was detected and resected, and the ends of the artery were closed with clips. No vasospasm was present. This case illustrates that neuroleptic drugs can cause neuroleptic malignant syndrome associated with acute respiratory distress syndrome. Neuroleptic malignant syndrome is a disease that is difficult to diagnose. Acute respiratory distress syndrome is another manifestation of neuroleptic malignant syndrome that has not been recognized in previous reports: it may be produced by neuroleptic drugs independent of the manifestation of neuroleptic malignant syndrome. Some considerations regarding the cause and effect relationship between acute respiratory distress syndrome and neuroleptic drugs are discussed. Intensive care unit physicians should consider the possibility that patients receiving neuroleptic drugs could develop respiratory failure in the absence of other factors that might explain the syndrome.

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Section: Introductionmentioning

confidence: 99%

Neuroleptic-induced acute respiratory distress syndrome

2003

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“…Without additional explanation, high levels of CPK at rest raise the suspicion of myopathy. These changes are common and do not justify plasma CPK measurement in the general population 39.…”

Section: Laboratory -Susceptibility To Mhmentioning

confidence: 99%

“…In other families, the gene involved is still unknown 39 . Furthermore, despite the MHS1 mutation being the only direct genetic cause for MHS, the additional presence of MHS3, MHS4, or MHS6 mutations may interact and increase the phenotype expression in some individuals 40 .…”

Section: Genetic Testingmentioning

confidence: 99%

Hipertermia maligna: aspectos moleculares e clínicos

Correia

Silva

2012

Rev. Bras. Anestesiol.

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Summary: Correia ACC, Silva PCB, Silva BA -Malignant Hyperthermia: Clinical and Molecular Aspects. Content:Malignant hyperthermia (MH) is a potentially lethal pharmacogenetic disorder that affects genetically predisposed individuals. It manifests in susceptible individuals in response to exposure to Inhalant anesthetics, depolarizing muscle relaxants or extreme physical activity in hot environments. During exposure to these triggering agents, there is a rapid and sustained increase of myoplasmic calcium (Ca 2+ ) concentration induced by hyperactivation of ryanodine receptor of skeletal muscle (RyR1), causing a profound change in Ca 2+ homeostasis, featuring a hypermetabolic state. RyR1, Ca 2+ release channels of sarcoplasmic reticulum, is the primary locus for MH susceptibility. Several mutations in the gene encoding the protein RyR1 have been identified; however, other genes may be involved. Actually, the standard method for diagnosing MH susceptibility is the muscle contracture test for exposure to halothane-caffeine (CHCT) and the only treatment is the use of dantrolene. However, with advances in molecular genetics, a full understanding of the disease etiology may be provided, favoring the development of an accurate diagnosis, less invasive, with DNA test, and also will provide the development of new therapeutic strategies for treatment of MH. Thus, this brief review aims to integrate molecular and clinical aspects of MH, gathering input for a better understanding of this channelopathy.

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“…There are a known sameness between the clinical symptoms of NMS and malignant hyperthermia (MH) [6]; therefore several reports have incited some controversy regarding the safety of the use of known triggering agents of MH such as succinylcholine in patients with a history of NMS [6–8]. Anesthesia and muscle relaxation for ECT in such patients poses specific challenges to anesthesiologists.…”

Section: Introductionmentioning

confidence: 99%

Propofol-Remifentanil Combination for Management of Electroconvulsive Therapy in a Patient with Neuroleptic Malignant Syndrome

Arasteh

Shami

Nasseri

2012

Case Reports in Medicine

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Electroconvulsive therapy can be effective in severe or treatment resistant neuroleptic malignant syndrome patients. Anesthesia and use of muscle relaxant agents for electroconvulsive therapy in such patients may encounter anesthesiologists with specific challenges. This case report describes successful management of anesthesia in 28-year-old male patient undergoing eight electroconvulsive therapy sessions for treatment of neuroleptic malignant syndrome.

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Susceptibilidade à hipertermia maligna em três pacientes com síndrome maligna por neurolépticos

Cited by 9 publications

References 25 publications

Neuroleptic-induced acute respiratory distress syndrome

Neuroleptic-induced acute respiratory distress syndrome

Hipertermia maligna: aspectos moleculares e clínicos

Propofol-Remifentanil Combination for Management of Electroconvulsive Therapy in a Patient with Neuroleptic Malignant Syndrome

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