Back
 OJAnes  Vol.5 No.4 , April 2015
Dantrolene in the Treatment of Refractory Hyperthermic Conditions in Critical Care: A Multicenter Retrospective Study
Abstract: Purpose: To examine the use of intravenous dantrolene in hospitalized patients. Materials and Methods: Medical Records of patients treated with intravenous dantrolene between 2007 and 2012 at 6 teaching hospitals were reviewed. Temperature, muscle rigidity, creatine kinase levels, and mortality were assessed in association with dantrolene use. Results: Twenty-five patients received intravenous dantrolene, 9 patients with neuroleptic malignant syndrome (NMS), 8 with hyperthermia due to sepsis, 4 with NMS and sepsis, 2 for malignant hyperthermia (MH), and 2 with hypermetabolic syndrome associated with juvenile diabetic ketoacidosis. Dantrolene was administered as a bolus of 1 - 3 mg/kg. Core temperature decreased after dantrolene administration in all groups but significant only for MH, NMS cases (Pre 102.3 ± 0.9°F vs. Post 99.5 ± 0.9°F; p < 0.001), in Sepsis cases (Pre 104.3 ± 1.5°F vs. Post 100.6 ± 1.0°F; p < 0.001). Mean rigidity scores decreased in all groups but significant only for NMS cases, and mean CK did not change significantly in any group. Conclusion: Dantrolene was associated with reductions in temperature and rigidity in hyperthermia of diverse origins in patients admitted to Intensive care settings.
Cite this paper: Pawar, S. , Rosenberg, H. , Adamson, R. , LaRosa, J. and Chamberlain, R. (2015) Dantrolene in the Treatment of Refractory Hyperthermic Conditions in Critical Care: A Multicenter Retrospective Study. Open Journal of Anesthesiology, 5, 63-71. doi: 10.4236/ojanes.2015.54013.
References

[1]   Gillman, P.K. (2010) Neuroleptic Malignant Syndrome: Mechanisms, Interactions, and Causality. Movement Disorders, 25, 1780-1790.
http://dx.doi.org/10.1002/mds.23220

[2]   Wappler, F. (2001) Malignant Hyperthermia. European Journal of Anaesthesiology, 18, 632-652.
http://dx.doi.org/10.1046/j.1365-2346.2001.00888.x

[3]   Musselman, M.E. and Saely, S. (2013) Diagnosis and Treatment of Drug-Induced Hyperthermia. American Journal of Health-System Pharmacy, 70, 34-42.
http://dx.doi.org/10.2146/ajhp110543

[4]   Eyer, F. and Zilker, T. (2007) Bench to Bedside Review: Mechanisms and Management of Hyperthermia Due to Toxicity. Critical Care, 11, 236.
http://dx.doi.org/10.1186/cc6177

[5]   McAllen, K.J. and Schwartz, D.R. (2010) Adverse Drug Reactions Resulting in Hyperthermia in the Intensive Care Unit. Critical Care Medicine, 38, 244-252.
http://dx.doi.org/10.1097/CCM.0b013e3181dda0d4

[6]   Boyer, E.W. and Shannon, M. (2005) The Serotonin Syndrome. The New England Journal of Medicine, 352, 1112-1120.
http://dx.doi.org/10.1056/NEJMra041867

[7]   Lefkowitz, D., Ford, C.S., Rich, C., Biller, J. and McHenry Jr., L.C. (1938) Cerebellar Syndrome Following Neuroleptic Induced Heat Stroke. Journal of Neurology Neurosurgery and Psychiatry, 46, 183-185.
http://dx.doi.org/10.1136/jnnp.46.2.183

[8]   Hadad, E., Weinbroum, A.A. and Ben-Abraham, R. (2003) Drug Induced Hyperthermia and Muscle Rigidity: A Practical Approach. European Journal of Emergency Medicine, 10, 149-154.
http://dx.doi.org/10.1097/00063110-200306000-00018

[9]   Adnet, P., Levstavel, P. and Krivosic-Horber, R. (2000) Neuroleptic Malignant Syndrome. British Journal of Anaesthesia, 85, 129-135.
http://dx.doi.org/10.1093/bja/85.1.129

[10]   Denborough, M.A. (1982) Heat Stroke and Malignant Hyperpyrexia. The Medical Journal of Australia, 1, 204-205.

[11]   Meyers, E.F. and Meyers, R.W. (1982) Thermic Stress Syndrome. JAMA, 247, 2098-2099.
http://dx.doi.org/10.1001/jama.1982.03320400018018

[12]   Strawn, J.R., Keck, P.E. and Caroff, S.N. (2007) Neuroleptic Malignant Syndrome. American Journal of Psychiatry, 164, 870-876.
http://dx.doi.org/10.1176/ajp.2007.164.6.870

[13]   Grunau, B.E., Wiens, M.O. and Brubacher, J.R. (2010) Dantrolene in the Treatment of MDMA-Related Hyperpyrexia: A Systematic Review. Canadian Journal of Emergency Medicine, 12, 435-442.

[14]   Kurz, A. (2008) Physiology of Thermoregulation. Best Practice & Research Clinical Anaesthesiology, 22, 627-644.
http://dx.doi.org/10.1016/j.bpa.2008.06.004

[15]   Krause, T., Gerbershagen, M.U., Fiege, M., Weibhorn, R. and Wappler, F. (2004) Dantrolene—A Review of Its Pharmacology, Therapeutic Use and New Developments. Anaesthesia, 59, 364-373.

[16]   Rosenberg, H., Davis, M., James, D., Pollock, N. and Stowell, K. (2007) Malignant Hyperthermia. Orphanet Journal of Rare Diseases, 2, 21.
http://dx.doi.org/10.1186/1750-1172-2-21

[17]   Davis, J.M., Caroff, S.N. and Mann, S.C. (2000) Treatment of Neuroleptic Malignant Syndrome. Psychiatric Annals, 30, 325-331.
http://dx.doi.org/10.3928/0048-5713-20000501-10

[18]   Caroff, S.N. (2003) Neuroleptic Malignant Syndrome. In: Man, S.C., Caroff, S.N., Keck Jr., P.E. and Lazarus, A., Eds., Neuroleptic Malignant Syndrome and Related Conditions, 2nd Edition, American Psychiatric Publishing, Washington, DC, 1-44.

[19]   Shalev, A., Hermesh, H. and Munitz, H. (1989) Mortality from Neuroleptic Malignant Syndrome. Journal of Clinical Psychiatry, 50, 18-25.

[20]   Reulbach, U., Dutsch, C., Biermann, T., Sperling, W., Thuerauf, N., Kornhuber, J. and Bleich, S. (2007) Managing an Effective Treatment for Neuroleptic Malignant Syndrome. Critical Care, 11, R4.

[21]   Rosebush, R.L., Stewart, T. and Mazurek, M.F. (1991) The Treatment of Neuroleptic Malignant Syndrome. Are Dantrolene and Bromocriptine Useful Adjuncts to Supportive Care? British Journal of Psychiatry, 159, 709-712.
http://dx.doi.org/10.1192/bjp.159.5.709

[22]   Ginz, H.F., Levano, S., Girard, T., Urwyler, A. and Hamel, C. (2012) Dantrolene for Severe Rhabdomyolysis in Staphylococcus aureus Toxic Shock Syndrome. European Journal of Anaesthesiology, 29, 161-162.
http://dx.doi.org/10.1097/EJA.0b013e32834c7c9d

[23]   Levenson, J.L. (1985) Neuroleptic Malignant Syndrome. American Journal of Psychiatry, 142, 1137-1145.
http://dx.doi.org/10.1176/ajp.142.10.1137

[24]   ACCP/SCCM (1992) American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: Definitions of Sepsis and Organ Failure and Guidelines for the Use on Innovative Therapies in Sepsis. Critical Care Medicine, 20, 864-874.
http://dx.doi.org/10.1097/00003246-199206000-00025

[25]   Sachdev, P.S. (2005) A Rating Scale for Neuroleptic Malignant Syndrome. Psychiatry Research, 135, 249-256.
http://dx.doi.org/10.1016/j.psychres.2005.05.003

[26]   Nisijima, K. and Shioda, K. (2013) Temporal Changes in Serum Creatine Kinase Concentration and Degree of Muscle Rigidity in 24 Patients with Neuroleptic Malignant Syndrome. Neuropsychiatric Disease and Treatment, 9, 853-859.
http://dx.doi.org/10.2147/NDT.S45084

[27]   Rosenberg, M.R. and Green, M. (1989) Neuroleptic Malignant Syndrome. Review of Response to Therapy. JAMA Internal Medicine, 149, 1927-1931.
http://dx.doi.org/10.1001/archinte.1989.00390090009002

[28]   Sakkas, P., Davis, J.M., Janicak, P.G. and Wang, Z.Y. (1991) Drug Treatment of the Neuroleptic Malignant Syndrome. Psychopharmacology Bulletin, 27, 381-384.

[29]   Hollander, A.S., Olney, R.C., Blackett, P.R. and Marshall, B.A. (2003) Fatal Malignant Hyperthermia Like Syndrome with Rhabdomyolysis Complicating the Presentation of Diabetes Mellitus in Adolescent Males. Pediatrics, 111, 1447-1452.
http://dx.doi.org/10.1542/peds.111.6.1447

[30]   Morales, A.E. and Rosenbloom, A.L. (2004) Death Caused by Hyperglycemic Hyperosmolar State at the Onset of Type 2 Diabetes. Journal of Pediatrics, 144, 270-273.
http://dx.doi.org/10.1016/j.jpeds.2003.10.061

[31]   Carchman, R.M., Dechert-Zeger, M., Calikoglu, A.S. and Harris, B.D. (2005) A New Challenge in Pediatric Obesity: Pediatric Hyperglycemic Hyperosmolar Syndrome. Pediatric Critical Care Medicine, 6, 20-24.
http://dx.doi.org/10.1097/01.PCC.0000149134.61673.77

[32]   Kilbane, B.J., Mehta, S., Backeljauw, P.F., Shanley, T.P. and Crimmins, N.A. (2006) Approach to Management of Malignant Hyperthermia-Like Syndrome in Pediatric Diabetes Mellitus. Pediatric Critical Care Medicine, 7, 169-173.
http://dx.doi.org/10.1097/01.PCC.0000192340.09136.82

[33]   Hotchkiss, R.S. and Karl, I.E. (1994) Dantrolene Ameliorates the Metabolic Hallmarks of Sepsis in Rats and Improves Survival in a Mouse Model of Endotoxemia. Proceedings of the National Academy of Sciences of the United States of America, 91, 3039-3043.
http://dx.doi.org/10.1073/pnas.91.8.3039

 
 
Top