HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Kunio Asada Shinjiro Sasaki Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Mieno, S. Articles by Sasaki, S. Search for Related Content PubMed PubMed Citation Articles by Mieno, S. Articles by Sasaki, S. Related Collections Anesthesia Cardiac - other

Eur J Cardiothorac Surg 2003;24:458-460
© 2003 Elsevier Science NL

Case report

Neuroleptic malignant syndrome following cardiac surgery: successful treatment with dantrolene

Department of Thoracic and Cardiovascular Surgery, Osaka Medical College, 2-7 Daigakucho, Takatsuki, Osaka 569-8686, Japan

Received 14 March 2003; received in revised form 6 May 2003; accepted 12 May 2003.

^* Corresponding author. Tel.: +81-726-83-1221; fax: +81-726-84-6542
e-mail: tho050{at}poh.osaka-med.ac.jp

Neuroleptic malignant syndrome (NMS) is a rare idiosyncratic reaction to neuroleptic drugs, which is potentially fatal. It has been occasionally reported that NMS occurs subsequently after surgery. We report a case of a 53-year-old male patient who developed NMS following cardiac surgery due to the resumption of zotepine. The patient was attacked with hyperthermia, sweating, significant shivering, trembling of the fingers, disturbed consciousness and extreme muscle rigidity after the resumption of zotepine. Furthermore, laboratory measurements revealed increased levels of serum blood urea nitrogen, creatinine and creatine phosphokinase. In addition, elevation in white blood cell counts and myoglobinemia were also observed. After a diagnosis of NMS was established, administration of zotepine was stopped and treatments with administration of dantrolene and a large amount of fluid infusion intravenously were started. Following these treatments, the clinical symptoms subsided and the laboratory findings improved without need for hemodialysis. Dantrolene, which is able to effectively impede the abnormal flow of calcium from the sarcplasmic reticulum into the muscle cytoplasm, was beneficial to reduce the clinical symptoms of NMS. We hereby present a patient with NMS following cardiac surgery, and discuss its subsequent management.

Key Words: Neuroleptic malignant syndrome • Neuroleptics • Cardiac surgery • Dantrolene