Danger to life on the operating table

“My jaw hurts,” says the 52-Year-old, is looking at the Howard University Hospital in Washington, D. C. help. The mouth-jaw-face surgeons quickly: The broken lower jaw of the man. The Patient reported that he was attacked two days earlier.

The 52-Year-old has some diseases: He suffers from type 2 Diabetes, is infected with Hepatitis C, and hypertension. Due to Diabetes and he takes Metformin, against the high blood pressure Lisinopril. Some years ago Doctors had to remove a benign tumor in the chest area, this was done under local anesthesia. The man is a smoker for decades, with an average of about a pack per week.

Two days later, the OP takes place, in which the surgical jaw want to repair. Before the procedure, the man receives intravenous antibiotics to a bacterial infection, according to the Team Oluwole Fadahunsi in the “Journal Oral of Maxillofacial Surgery”. What happens, then, to describe you to the Minute.

At the beginning everything seems normal

15.52 PM: The Patient is pushed into the operating room. He gets five means to induce anaesthesia: Midazolam, Fentanyl, Propofol, Rocuronium, and Succinylcholine. Subsequently, a physician intubated him, to give him during the procedure artificial.

16 p.m.: The anesthesiologist administered to the man on the ventilator, the gaseous anesthetic Desflurane. The Patient receives additional doses of some of the additional funds.

16.32 PM: The Operation begins. At first, everything seems to be normal.

17 p.m.: A half hour later, the anesthesia doctor registered, however, an unusual value. The carbon dioxide amount, which the man exhales, rises. The oxygen saturation of the blood, however, lies more in the normal range, the heart beat at the desired Tempo, the blood pressure is stable.

In the following half hour, the carbon dioxide amount in the exhaled air, also the man’s heart begins to beat faster. His body temperature was still 35.3 degrees Celsius, is now of 36.3 degrees Celsius.

17.45: The patient’s condition has further deteriorated. The surgeon, it is striking that a masseter muscle called the Musculus masseter is tense.

The anesthesia doctor now has an idea of what the Patient suffers from and what kind of danger he floats. He says the surgeon, that you must stop the Operation immediately, turn off the Desflurane-feed and calls for a further anaesthetist to gain.

During the surgeons to perform the last necessary handles, sets of the anesthesiologist to the man with a mask and ventilated him, to supply him with sufficient oxygen. In addition, he administered dantrolene, the patient a dose of drug, the muscles relaxed.

17.52 PM: The surgeons finish the procedure. For the anesthesia doctors, the really critical Phase is about to begin. You may immediately place cool packs around the body of the patient.

18 clock: The temperature of the man rising, in spite of this measure, to 39.1 degrees Celsius. His heart is racing with 173 beats per Minute, his blood pressure is a threat has increased and is 200 to 100. The good news is that The carbon dioxide value in the exhaled air decreases.

Also, the other values are reverting back, the heart beats slower, the temperature drops, the blood pressure also. For further treatment, the anesthesia, the doctors bring the patients to the surgical intensive care unit.

The 52-Year-old has a so-called malignant hyperthermia, translated a malicious Overheating. The Problem is genetic, when Concerned with certain anesthetics can trigger devastating reactions in the muscle cells. The cells are activated, in principle, permanently, which is why the energy and oxygen consumption by leaps and bounds is increasing.

As a result, the temperature of the body is increased. Similarly, the carbon Dioxide rises in the blood, leading to a dangerous Acidification. Later on, the muscles can decompose due to the Overcharge even, what else can happen, for example, by extreme and one-sided loads in the Sport.

With the drug dantrolene, which relaxes the muscles, the dangerous Problem. Much better, however, to recognize prior to SURGERY under General anesthesia, if patients have a predisposition to malignant hyperthermia.

His sister died almost

A clear warning sign is when relatives have received the diagnosis, because the cause is genetic, therefore inherited. In the aftermath of the husband remembers that his sister had died a few years ago during an Operation under full anaesthesia almost. Prior to his engagement, he replied in the negative the question of whether in his family, SURGICAL complications are well known.

The suspicion of malignant hyperthermia, this can be due to Tests before the SURGERY to clarify. Anesthesiologist can perform anesthesia without those substances, which lead to the problems.

The Patient fully recovers from the dangerous incident. The Doctors explain to him why the anesthesia was so dangerous. They also warn his Relatives: If you have a procedure under General anesthesia is necessary, you should report to the Doctors that they may develop malignant hyperthermia.