Resume Le baclofene est indique dans le traitement de la spasticite post-traumatique. Il comporte non seulement des risques de surdosage, mais aussi de sevrage. Nous rapportons ici deux cas d'hypertonie severe avec hyperthermie grave (> 42 °C), survenus lors de l'arret accidentel d'une perfusion intrathecale continue de baclofene. L'hypertonie et l'hyperthermie ont cede a la reintroduction du baclofene. Elles etaient cependant accompagnees de perturbations graves des fonctions hepatique (cytolyse), hematologique (coagulopathie de consommation), respiratoire et hemodynamique. Ces troubles ont disparu en quelques jours. En consequence, chez des patients qui recoivent du baclofene au long cours, principalement par voie intrarachidienne, il convient de prevenir un syndrome de sevrage et surtout d'en detecter les premiers signes. La parente avec les autres hyperthermies malignes est discutee.

Hyperthermie grave liée à un sevrage brutal de baclofène administré de façon continue par voie intrathécale

Acute asthma is well known to provoke complications. We report the case of a patient who needed intubation and mechanical ventilation for acute asthma. Despite a treatment with corticosteroids, bronchodilators, neuromuscular blocking drugs and magnesium sulfate, the situation remained uncontrolled and as a last resort, halothane became necessary. The patient then developed an episode of malignant hyperthermia with fever at 40 degrees C and rhabdomyolysis. At this time, halothane could be stopped and all the symptoms disappeared without modifying the rest of the treatment. Eight days later, he presented with a neuroleptic malignant syndrome following an injection of droperidol. Temperature rose to 42 degrees C, associated with muscle rigidity, sweating, tachycardia and severe circulatory collapse. The use of dantrolene in association with a symptomatic treatment of the collapse led to a favourable outcome in. Unfortunately, in vitro contracture test could not be performed in this case. The links between malignant hyperthermia and neuroleptic malignant syndrome remain unclear. Although these two pathologies share the same physiopathology, symptomatology and treatment, they are clearly individualized. This case seems to be the first description of their occurrence in the same patient.

Malignant hyperthermia and neuroleptic malignant syndrome in a patient during treatment for acute asthma

We report a case of per anaesthesia malignant hyperthermia (MH) arisen in a 16-year-old young man presenting antecedents of five anaesthesia with use of halogenated agents without complication and having started a typical crisis of MH after five hours of anaesthesia with sevoflurane and with recurrence of the crisis after 14 hours in ICU. The association in the same clinical case of these three peculiarities of the crisis of MH already described separately in the international literature allows us to insist on their importance, with the French-speaking anaesthesiologists community.

Crise d’hyperthermie maligne de l’anesthésie après cinq heures d’anesthésie avec le sévoflurane et plusieurs anesthésies antérieures avec halogénés

Resume Objectif Etudier la possibilite de differencier cliniquement en cours d'intervention une crise d'hyperthermie maligne (HM) d'un etat septique. Type d'etude Etude comparative, retrospective de dossiers cliniques. Patients Seize sujets operes d'appendicite aigue ayant eu des signes cliniques evocateurs d'HM, confirmee ou non par des tests de contracture halothane-cafeine (TCHC). Methode Degager les caracteristiques des patients, tant en ce qui concerne le diagnostic de sepsis que celui de crise d'HM. Comparer ces deux groupes de signes aux resultats des TCHC. Resultats Le diagnostic de sensibilite a l'HM a ete elimine chez dix sujets et confirme chez six autres par les TCHC. II n'existait pas de relation entre l'importance du sepsis periope-ratoire et les signes d'HM, pas plus que les resultats des tests de contracture. Conclusions Cette etude confirme que le diagnostic entre HM et etat septique est difficile en cours d'intervention. Aussi la gravite de l'HM justifie-t-elle la mise en route du traitement specifique, meme en presence d'un sepsis appendiculaire.

Hyperthermie maligne et état infectieux d'origine appendiculaire. Peut-on les différencier en cours d'intervention ?

Hyperthermia, skeletal muscle rigidity, rhabdomyolysis, acidosis and multiple system insufficiency characterize malignant hyperthermia. Anaesthetic malignant hyperthermia follows halogenated volatile agents and/or depolarizing muscle relaxants utilization. Diagnosis is based on in vitro muscle contracture in response to halothane and/or caffeine exposure. Neuroleptic malignant syndrome affects patients taking neuroleptic drugs; clinical findings include hyperthermia, extrapyramidal rigidity, acidosis, neurovegetative instability and neurological signs. We report three neuroleptic malignant syndrome patients with positive muscle contracture tests which shows that muscle from neuroleptic malignant syndrome patients may in some instances show alterations similar to those of anaesthetic malignant hyperthermia.

https://www.scielo.br/pdf/anp/v58n3A/2563.pdf

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

The aim of this study was to verify whether a relationship exists between neuroleptic malignant syndrome (NMS) and anaesthetic-induced malignant hyperthermia (MH) or not. The in vitro halothane-caffeine tests were performed on muscle tissue obtained from 32 patients with documented NMS episodes. The diagnosis of NMS relied on Levenson's criteria. The results, expressed in accordance with the criteria of the European MH Group, defined 29 subjects as MH non-susceptible. Three patients were classified as MH equivocal. These findings demonstrate the lack of any link between NMS and MH. Therefore, patients with a history of NMS are not likely to be at risk of developing MH and special measures against MH are not required for anaesthesia in these patients.

Absence de sensibilité à l'hyperthermie maligne peranesthésique chez 32 patients ayant développé un syndrome malin des neuroleptiques

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Absence de sensibilité à l'hyperthermie maligne peranesthésique chez 32 patients ayant développé un syndrome malin des neuroleptiques