Clinical treatment of malignant hyperthermia in three cases

Abstract

Malignant hyperthermia (MH) is a rare life threatening inherited disorder that is triggered by drugs used for general anesthesia in susceptible persons. The symptoms include rapid increase of body temperature and severe muscle contractions. The present study includes 3 cases of MH and highlights the timely identification of symptoms for rescuing the patient. In case I, a 7-year-old male child underwent surgery with ketamine at a dose of 250 mg. After 4 h of operation, the child went through convulsions, high fever and succumbed within a few hours. High fever was not detected in a timely manner, which is one of the main symptoms of MH. In case II, a 12-year-old male child had convulsions and high fever after simple surgery caused by MH. Once confirmed, immediate measures were taken to lower the body temperature and the child was rescued. In case III, a male 57-year-old was admitted to hospital due to paraplegia. The patient underwent more critical conditions once symptoms of MH appeared. Additionally, antidote dantrolene was unavailable in the first and third case; thus, the progression of disease was not alleviated although active symptomatic and supportive treatment were employed.

Malignant Hyperthermia in Bariatric Surgery: A Case Study With Clinical, Pathophysiological, Biochemical and Biophysical Correlations

“…In some cases, dantrolene was administered immediately after the MH crisis triggering, both during the intraoperative [ 4 , 13 , 40 , 49 , 50 ] and postoperative [ 32 , 51 , 52 ] periods and all patients were discharged from the hospital in stable conditions. Late addition of dantrolene is also reported in intra- and postoperative MH cases with different results, and some were fatal, while others had no additional complications [ 2 , 45 , 53 , 54 ]. On the other hand, there were related intra- [ 28 , 55 ] and postoperative [ 54 ] MH cases in which dantrolene was not administrated due to non-availability of the drug in the hospital.…”

“…Late addition of dantrolene is also reported in intra- and postoperative MH cases with different results, and some were fatal, while others had no additional complications [ 2 , 45 , 53 , 54 ]. On the other hand, there were related intra- [ 28 , 55 ] and postoperative [ 54 ] MH cases in which dantrolene was not administrated due to non-availability of the drug in the hospital. Iqbal et al (2017) [ 28 ] reported the clinical signs and laboratory parameters altered by the MH crisis were reversed with internal (ice cold saline intravenously) and external (ice packs and cold towels over the body) cooling, and the patient had full recovery before being discharged.…”

“…Iqbal et al (2017) [ 28 ] reported the clinical signs and laboratory parameters altered by the MH crisis were reversed with internal (ice cold saline intravenously) and external (ice packs and cold towels over the body) cooling, and the patient had full recovery before being discharged. Pan et al (2016) [ 54 ], in the case report III, described that the inhalation anesthetic was not used in the operation, but the body temperature rose slowly during the postoperative period and, after 2 days, the patient was in critical condition. Meanwhile, Lazraq et al (2019) [ 55 ] and Pan et al (2016) (case report I) [ 54 ] reported that patients had persistent high fever and died despite all the resuscitation procedures administered.…”

“…Pan et al (2016) [ 54 ], in the case report III, described that the inhalation anesthetic was not used in the operation, but the body temperature rose slowly during the postoperative period and, after 2 days, the patient was in critical condition. Meanwhile, Lazraq et al (2019) [ 55 ] and Pan et al (2016) (case report I) [ 54 ] reported that patients had persistent high fever and died despite all the resuscitation procedures administered. Unfortunately, in our case, dantrolene could not be used because it was not available at the hospital or in other hospitals in nearby cities and the patient died.…”

Desenvolvimento e avaliação de ambiente virtual de aprendizagem para capacitação em hipertermia maligna

“…Por ser uma desordem genética do músculo esquelético, implica na diminuição da recaptação de cálcio e na liberação descontrolada do mesmo. A síndrome ocorre em pacientes susceptíveis à exposição dos agentes desencadeantes utilizados para induzir a anestesia geral [12][13][14][15] .…”