Malignant Hyperthermia (MH) is a rare genetic disease. However, it is devastating when it occurs in a patient. MH is usually triggered by inhalational anesthetics and/or depolarizing muscle relaxants. Public awareness...Malignant Hyperthermia (MH) is a rare genetic disease. However, it is devastating when it occurs in a patient. MH is usually triggered by inhalational anesthetics and/or depolarizing muscle relaxants. Public awareness of MH has increased with the presentation of an episode on the television program, “House”, and the availability of web-based information. For over 20 years, the MH susceptible pig has been used in experiments by our group as an animal model for MH in humans. The incidence of Malignant Hyperthermia in the Greater Kansas City Area has declined dramatically since the introduction of Sevoflurane in 1992 as the anesthetic of choice (over 60% usage rate) in most surgical procedures. Historically, Malignant Hyperthermia was reported to occur at a rate of 1:50,000 during surgical procedures [1]. In the Greater Kansas City Area, Malignant Hyperthermia (MH) occurred at a rate of 1:53,636 during the 1965-1985 time period, as there were 38 MH cases in 35 patients [2]. During the past ten years (1996-2006), there were only 2 cases of MH, representing an incidence rate of 1:597,240. That decrease is an 11.13 fold (or 89%) decrease which is very significant. Despite the reduced incidence of Malignant Hyperthermia, two recent cases of MH that result in deaths in Wisconsin and Florida make it imperative that MH is recognized early and appropriate treatment initiated without delay. We have expanded our analysis of the futile cycle mechanism that underlies the MH syndrome. MH is equivalent to the rapid discharge of a battery by a short circuit.展开更多
背景心外手术过程中的高血压常难以控制，并进而影响手术疗效。氯维地平是一种新型的2-氢吡啶L型钙通道阻滞剂，可有效降低动脉压，起效迅速，且半衰期极短。氯维地平治疗围手术期高血压的安全性事件评估研究（evaluation of clevidipin...背景心外手术过程中的高血压常难以控制，并进而影响手术疗效。氯维地平是一种新型的2-氢吡啶L型钙通道阻滞剂，可有效降低动脉压，起效迅速，且半衰期极短。氯维地平治疗围手术期高血压的安全性事件评估研究（evaluation of clevidipine in the perioperative treatment of hypertension assessing safety events trial, ECLIPSE）旨在比较氯维地平（CLV）与硝酸甘油（NTG）、硝普钠（SNP）、尼卡地平（NIC）治疗心外手术患者急性高血压的疗效与安全性。方法我们分析了3项前瞻性、随机、开放性平行对照研究的资料，这些研究由61家医疗中心参与完成，比较了氯维地平与硝酸甘油、硝普钠、尼卡地平在心外手术患者的围手术期应用情况。共选择1964例患者，1512例按临床标准需紧急治疗高血压，符合随机化纳入标准。这些患者按1：1比例随机编入3个平行的对比治疗组。主要结局为30天内的死亡事件、心肌梗死、中风和肾功能不全，次要结局为血压控制的充分性与精确度的评估报告。结果氯维地平组与其他治疗组相比，心肌梗死、中风和肾功能不全的发生率均无显著差异。硝普钠治疗组与氯维地平组相比，死亡例数显著增加（P=0．04）。与硝酸甘油（P=0．0006）和硝普钠（P=0．003）相比，氯维地平能更有效地把血压控制在预定范围内。在控制血压于一个预定范围方面氯维地平与尼卡地平等效，但当预定血压控制范围较窄时，氯维地平较尼卡地平超出范围的幅度更小。结论氯维地平用于治疗心外手术患者的急性高血压安全有效。展开更多
文摘Malignant Hyperthermia (MH) is a rare genetic disease. However, it is devastating when it occurs in a patient. MH is usually triggered by inhalational anesthetics and/or depolarizing muscle relaxants. Public awareness of MH has increased with the presentation of an episode on the television program, “House”, and the availability of web-based information. For over 20 years, the MH susceptible pig has been used in experiments by our group as an animal model for MH in humans. The incidence of Malignant Hyperthermia in the Greater Kansas City Area has declined dramatically since the introduction of Sevoflurane in 1992 as the anesthetic of choice (over 60% usage rate) in most surgical procedures. Historically, Malignant Hyperthermia was reported to occur at a rate of 1:50,000 during surgical procedures [1]. In the Greater Kansas City Area, Malignant Hyperthermia (MH) occurred at a rate of 1:53,636 during the 1965-1985 time period, as there were 38 MH cases in 35 patients [2]. During the past ten years (1996-2006), there were only 2 cases of MH, representing an incidence rate of 1:597,240. That decrease is an 11.13 fold (or 89%) decrease which is very significant. Despite the reduced incidence of Malignant Hyperthermia, two recent cases of MH that result in deaths in Wisconsin and Florida make it imperative that MH is recognized early and appropriate treatment initiated without delay. We have expanded our analysis of the futile cycle mechanism that underlies the MH syndrome. MH is equivalent to the rapid discharge of a battery by a short circuit.
文摘背景心外手术过程中的高血压常难以控制，并进而影响手术疗效。氯维地平是一种新型的2-氢吡啶L型钙通道阻滞剂，可有效降低动脉压，起效迅速，且半衰期极短。氯维地平治疗围手术期高血压的安全性事件评估研究（evaluation of clevidipine in the perioperative treatment of hypertension assessing safety events trial, ECLIPSE）旨在比较氯维地平（CLV）与硝酸甘油（NTG）、硝普钠（SNP）、尼卡地平（NIC）治疗心外手术患者急性高血压的疗效与安全性。方法我们分析了3项前瞻性、随机、开放性平行对照研究的资料，这些研究由61家医疗中心参与完成，比较了氯维地平与硝酸甘油、硝普钠、尼卡地平在心外手术患者的围手术期应用情况。共选择1964例患者，1512例按临床标准需紧急治疗高血压，符合随机化纳入标准。这些患者按1：1比例随机编入3个平行的对比治疗组。主要结局为30天内的死亡事件、心肌梗死、中风和肾功能不全，次要结局为血压控制的充分性与精确度的评估报告。结果氯维地平组与其他治疗组相比，心肌梗死、中风和肾功能不全的发生率均无显著差异。硝普钠治疗组与氯维地平组相比，死亡例数显著增加（P=0．04）。与硝酸甘油（P=0．0006）和硝普钠（P=0．003）相比，氯维地平能更有效地把血压控制在预定范围内。在控制血压于一个预定范围方面氯维地平与尼卡地平等效，但当预定血压控制范围较窄时，氯维地平较尼卡地平超出范围的幅度更小。结论氯维地平用于治疗心外手术患者的急性高血压安全有效。
