Was wurde immer gesagt? "Das ist doch die älteste und häufigste Operation der Welt!"
Und die überflüssigste.
Leber- Nieren- und Atmungsversagen, Maligne Hyperthermie, Übersäurung, Hirnschaden, Schock, Lungenblutung, Kompartmentsyndrom, 25 Tage intubiert...
der Junge hat extrem viel durchgemacht, mit viel Glück überlebt, ob er sich je komplett erholen wird ist fraglich - alles wegen einer beschissenen "Routine-Zirkumzision". "Routine" hört sich verdammt nach "nicht-indiziert" an.
Keine medizinisch nicht notwendigen Operationen an Kinder!
Und die überflüssigste.
Leber- Nieren- und Atmungsversagen, Maligne Hyperthermie, Übersäurung, Hirnschaden, Schock, Lungenblutung, Kompartmentsyndrom, 25 Tage intubiert...
der Junge hat extrem viel durchgemacht, mit viel Glück überlebt, ob er sich je komplett erholen wird ist fraglich - alles wegen einer beschissenen "Routine-Zirkumzision". "Routine" hört sich verdammt nach "nicht-indiziert" an.
Keine medizinisch nicht notwendigen Operationen an Kinder!
insights.ovid.com/critical-car…8/01/001/529/495/00003246
Excerpt
Learning Objectives: Malignant Hyperthermia (MH) is a rare but life-threatening hypermetabolic syndrome associated with exposure to volatile anesthetics or Succinylcholine.
Methods: A 5-year-old boy underwent anesthetic induction for a routine circumcision with Sevoflurane and Nitrous oxide. At the end of the procedure, he developed Malignant Hyperthermia (temperature of 43 degrees C, metabolic acidosis and hyperkalemia) for which he was given four 60 mg doses of Dantrolene sodium (DS) IV. His course was complicated by respiratory failure, shock, leg muscle rigidity leading to Compartment syndrome, Disseminated intravascular coagulation and pulmonary hemorrhage with subsequent liver dysfunction and renal failure requiring continuous renal replacement therapy (CRRT). DS was discontinued on the second hospital day (HD). His liver function continued to deteriorate with peak AST, ALT and ammonia levels of > 7,000 U/L, 6,024 U/L and 107 μmol/L, respectively. He subsequently received two days of N-Acetyl Cysteine (NAC) to help rescue his metabolic liver failure. Liver function improved thereafter. He was extubated on HD 25. Brain MRI showed ACA/MCA watershed infarcts. By HD 35, renal function recovered and dialysis was discontinued. He was eventually discharged to rehabilitation services for muscle and cognitive rehabilitation. Genetic testing revealed a mutation in the ryanodine receptor 1 (RYR1).
Results: Multi-organ failure has been reported to be associated with severe cases of MH. Although liver dysfunction can be caused by severe hemodynamic compromise, DS has also been associated with metabolic liver toxicity. In previously reported cases, hepatotoxicity is associated with doses > 400 mg/day and at lower doses with chronic oral therapy; our patient received a total of 710 mg over 48 hours. Although his liver dysfunction was likely multifactorial, it persisted despite CRRT and did not resolve until administration of NAC. This case underscores the need for hepatic monitoring in cases of MH treated with DS and highlights the utility of NAC as a rescue therapy for hepatic support.
Vorhaut hat Vorteile. Sonst gäbe es sie nicht.