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Published April 16, 2008 10:12 pm -

Anesthesiologist saves a life
Rare genetic disorder manifests during surgery

Lori Glenn

MOULTRIE — Rarely does the spotlight shine on an anesthesiologist, but Colquitt Regional Medical Center’s Dr. Charese Pelham and her support team deserve credit for saving a little girl’s life.

A 6-year-old girl came in to Colquitt Regional Medical Center Jan. 15 for a routine tonsillectomy. Anesthetist John Norman and a student anesthetist, Mandy Davidson, were in the operating room with her, and Pelham was elsewhere in the department keeping up through a handheld radio.

The case was ending. Everything up to that point was fine, she said, but the girl’s carbon dioxide output was going up. So Pelham had them push the bag breather faster, but the CO2 didn’t go down. Normal end-title CO2 levels are between 40 and 45, Pelham said. Norman radioed Pelham when the level was at 50. By the time she rushed down the hall, it had soared to 100.

Pelham quickly realized it was malignant hyperthermia (MH) crisis. MH, a rare genetic syndrome, hit national news at the end of March. It was the cause of the sudden death of a Florida teen cheerleader after she went in for a cosmetic procedure. MH can kill and can kill quickly if not stopped early. Temperatures can spike up to 112 degrees.

“It could cook your brain,” Pelham said.

Pelham set about trying to stave off temperature spikes by packing ice under the girl’s arms and groin area, and pushing iced saline and a muscle relaxer, dantrolene, intravenously.

To work an MH crisis takes between 15 and 20 people, Pelham said. She had at least 15 people working on the little girl, grabbing every available nurse and support personnel she could. They cranked the air conditioning to 62 degrees.

“This can shut your kidneys down, shut all your organs down and can kill you really quickly. Then the muscles start to contract and release huge amounts of potassium, which can stop the heart. You’ve got everybody working hard as they can,” she said. “We were freezing our butts off in there, but her temperature never got below 98.”

Malignant hyperthermia is an autosomal dominant genetic disease, meaning it is passed usually from generation to generation.

“Most of the time, you would never know you have it — ever,” she said.

It’s so rare — striking one out of every 15,000 to 20,000 people — most anesthesiologists go their entire careers and never see one, she said. And it’s indiscriminate.

“It doesn’t matter what surgery you’re in for,” she said.

MH can present within minutes of the trigger or a day later, she said. Certain triggers, such as some anesthesias, can set off MH. The most potent trigger is succinylcholine chloride or Anectine, which is used to induce muscle relaxation.

“It’s a very good drug. It’s a commonly used drug,” she said, adding advantages are quick onset and offset. “However, because of its potency as a possible MH trigger, we try to avoid using it on children if we can.”

Less of a trigger but a trigger nonetheless is anesthesia inhaled gases with the exception of nitrous oxide, commonly known as laughing gas.



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