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Magnesium as Immediate Management for Suspected Intraoperative Malignant Hyperthermia Crisis: A Case Report from Indonesia Farida Soenarto, Ratna; Kusuma Manggala, Sidharta; Montolalu, Gabriela; Listyana, Tia; Kurniawan, Celine
Majalah Anestesia & Critical Care Vol 43 No 2 (2025): Juni
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif (PERDATIN) / The Indonesian Society of Anesthesiology and Intensive Care (INSAIC)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55497/majanestcricar.v43i2.437

Abstract

Background: Malignant hyperthermia (MH) is a life-threatening disorder triggered by certain anesthetics and characterized by a hypermetabolic state in skeletal muscles. Magnesium sulfate is gaining recognition as a crucial adjunct in the immediate management of MH, particularly when dantrolene is not readily available. This case report presents a successful use of magnesium during an MH crisis, emphasizing its potential as a life-saving intervention in resource-limited settings. The report adds to the growing evidence supporting magnesium's role in early MH management, especially when there is a delay in dantrolene administration.Case Illustration: A 2-year-old healthy boy underwent Achilles tendon lengthening under general anesthesia. Post-induction, the patient developed signs of increased sympathetic activity, muscle rigidity, and hypercarbia. Due to dantrolene unavailability, 400 mg of magnesium sulfate was administered, which successfully reduced muscle rigidity and stabilized hemodynamics. Dantrolene was later given, further improving the patient's condition. The patient was extubated 28 hours later and fully recovered, highlighting the critical role of magnesium in managing this crisis.Conclusion: Early detection and management of MH are crucial for patient survival. In the absence of dantrolene, MgSO4 serves as an effective alternative for immediate intervention. This experience underlines the importance of having alternative treatment strategies in resource-limited settings and stresses the need for continued education and preparedness for MH crises.
Respiratory Failure and Hypercoagulable State in Creutzfeldt-Jakob Disease: A Rare Case Report Kurniawan, Celine; Manggala, Sidharta Kusuma
Solo Journal of Anesthesi, Pain and Critical Care (SOJA) Vol 5, No 1 (2025): April 2025
Publisher : Fakultas Kedokteran Universitas Sebelas Maret Surakarta

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20961/soja.v5i1.91846

Abstract

Background:Creutzfeldt-Jakob Disease (CJD) is a rare, rapidly progressive neurodegenerative disorder caused by prion proteins. It is characterized by a variety of neurological symptoms that lead to severe cognitive decline and death. The uniqueness of this case lies in the severe complications of respiratory failure and a hypercoagulable state, which are not commonly highlighted in the literature. Reporting this case underscores the critical need for awareness and management strategies for such complications in CJD patients, which can significantly impact their clinical outcomes and quality of life.Case Illustration:A 69-year-old female presented with progressively worsening neurological symptoms over a short period. Initially, she experienced visual disturbances and hallucinations, followed by a rapid decline in consciousness, the onset of seizures, and myoclonus. Diagnostic investigations, including an electroencephalogram (EEG) and Magnetic Resonance Imaging (MRI), confirmed the diagnosis of Creutzfeldt-Jakob Disease (CJD).As her condition deteriorated, the patient developed pneumonia and septic shock. Excessive salivary secretion, a symptom often overlooked in CJD, led to significant respiratory compromise and failure. She was admitted to the intensive care unit (ICU) and required mechanical ventilation. Due to the prolonged need for ventilation and to manage airway secretions better, a tracheostomy was performed.Management of her respiratory failure involved meticulous care to reduce hypersalivation and prevent micro-aspiration. Regular suctioning of secretions was crucial. Additionally, given her immobility and increased risk of thromboembolism, she received prophylactic heparin to prevent venous thromboembolism. Physiotherapy was initiated to maintain limb mobility, and elastic stockings were used to reduce the risk of deep vein thrombosis.Conclusion:This case report highlights the complex clinical challenges in managing a patient with CJD, particularly the severe respiratory and thromboembolic complications. The comprehensive approach to managing respiratory failure through tracheostomy and proactive measures to prevent thromboembolism was essential in stabilizing the patient. However, the incurable nature of CJD meant that the focus ultimately shifted to palliative care. This case underscores the importance of recognizing and managing secondary complications in CJD to improve patient outcomes and the need for ongoing research into effective treatments for this devastating disease.