Neurology Edited by Professor Emeritus Desire' Dubounet, IMUNE

Hints of predispositionEarlier anaesthetic mishaps, family history of muscle diseases, myalgia with fever, dark urineafter anaesthesia, or spontaneous, unexplained deaths in the family. Raisedphosphocreatine-kinase (in about 70% prior to drug exposure), skeletal deformities(scoliosis, abnormal feet), flaccid connective tissue with propensity to hernias.Diagnostic testsCreatine kinase, TRH test, lipid electrophoresisMuscle ischaemia test with lactate and ammonium estimationEMGMuscle biopsy under local anaesthesia for histology, histochemistry and in vitro study ofhalothane-induced contracture.ManagementWithdrawal of potential trigger substancesInfusion of dantrolene sodiumVentilation and iv injection of sodium bicarbonate according to degree of acidosisCoolingDiureticsIf further anaesthesia is required: neuroleptanalgesia, nitrous oxide, barbiturates,benzodiazepines, pancuronium.ProphylaxisRegistration of patients at risk of malignant hyperpyrexiaIf possible use local anaesthesia, otherwise use prophylactic dantrolene 30min beforeanaesthesiaAnaesthetize with barbiturates, opiates, benzodiazepines, nitrous oxide, pancuronium.Causes of myoglobinuriaHEREDITARYMcArdle's disease (muscle phosphorylase deficiency)Phospho-fructokinase deficienceyCarnitine-paimityl-transferase deficiencyMalignant hyperpyrexia.AQUIREDMuscular overload (sport, tibialis anterior syndrome, epileptic fits, tetanus, dystonias,alcoholic delirium, catatonia)Trauma, infection, electric shock, burns, air embolism, prolonged coma, heat stroke,hypothermia, barotrauma, toxic shock syndrome, sepsis