ABSTRACT
A 60-year-old patient claimed that epidural anesthesia prescribed for post operative pain control after knee replacement surgery was prolonged and caused neurological deficits in lower limbs and feet. The patient requires braces to walk. The patient claimed that hospital staff should have noticed tingling and loss of motion in limbs and stopped the epidural analgesia. A five million dollar settlement was reached prior to trial without acknowledgment of liability by the hospital or anesthesiologist. Anesthesia
HALOTHANE: M ALIG NANT HYPERTHERM IA FO LLO W ED BY NEUROLOGIC M ALIG NANT SYNDRO M E (FIRST REPORT*)
A 36-year-old asthmatic patient in the intensive care unit developed malig nant hyperthermia after the administration of supportive therapy for the treat ment of severe bronchospasm with respiratory acidosis (pH = 7.27, PaC02 = 8.5, kPa = 10.3, kPa with F I02 = 29 mEq/L, BE = +1). Therapy included vecuronium bromide (dosage not provided), magnesium sulfate (400 mg/hr) and halothane 0.4%. Although respiratory symptoms and blood gas values improved, the patient’s fever gradually increased to 40°C during halothane treatment. No change in muscle tone was noted at this time suggesting malig nant hyperthermia. Oxygen saturation during this time was unchanged. How ever, evidence of rhabdomyolysis was supported by elevated CPK levels (5205 UI/L) and myoglobinemia (8240 mcg/L). Potassium levels increased to 5.1 mmol/L and leukocytosis decreased (20/mL). Serum bacteriological samples
remained sterile during fever peaks, suggesting a non-infective etiology. Once halothane therapy was discontinued, the fever resolved spontaneously.
