Development of malignant hyperthermia during cardiopulmonary bypass

Lindholm, Peter; Andersen, S.S.; Andersen, Claus B.; Fisker, Jørgen

doi:10.1053/jcan.2000.9444

Cited by 10 publications

(5 citation statements)

References 10 publications

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“…Cardiopulmonary bypass (CPB) and moderate hypothermia during CPB can obscure the clinical signs of MH and make the diagnosis difficult. The development of MH during cardiopulmonary bypass (CPB) is rare (1–5). Several reported cases are doubtful due to lack of biopsies (1–4).…”

mentioning

confidence: 99%

Sevoflurane‐induced malignant hyperthermia during cardiopulmonary bypass and moderate hypothermia

Jonassen¹,

Petersen²,

Mohr

et al. 2004

Acta Anaesthesiol Scand

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A 56-year old man was admitted for elective mitral valve repair and coronary artery bypass surgery due to mitral valve leakage and unstable angina. After induction of anaesthesia he developed a combined metabolic and respiratory acidosis. Different diagnosis were considered and we decided to treat the patient with dantrolene due to suspicion of malignant hyperthermia (MH). The patient received one dose of dantrolene 2,5 mg/kg during cardiopulmonary bypass (CPB) and a second dose of dantrolene 2,5 mg/kg during weaning from CPB. The first arterial blood gas sample taken in the intensive care unit showed relapse of the acidosis and we administered an infusion of 150 mg dantrolene over 3 hours. The patient gradually recovered without sequel and MH was verified by muscle biopsy testing.

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mentioning

confidence: 99%

Sevoflurane‐induced malignant hyperthermia during cardiopulmonary bypass and moderate hypothermia

Jonassen¹,

Petersen²,

Mohr

et al. 2004

Acta Anaesthesiol Scand

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“…In our study, a mild CO 2 washout could have contributed to alkaline pH as the baseline samples were collected during ventilation. Intraoperatively, despite non-dramatic pCO 2 elevations, the percentage increase in blood pCO 2 was comparable to that in MH [24][25][26]. Additionally, in contrast to halothane, that causes rapid MH-dependent rise in blood pCO 2 , with newer volatile anesthetic agents, this is more gradual and can be masked by adjustments of ventilator settings during surgery [27,28] On the contrary, a prolonged time in the building up of intraoperative endtidal CO 2 (ETCO 2 ), an adjunct to arterial pCO 2 (elevated in recipients 1 and 2), and a high venous-arterial pCO 2 gradient (as in donors 1, 3 and recipient 1), are independent predictors of poor surgical outcomes [29,30].…”

Section: Discussionmentioning

confidence: 60%

The Progression of Isoflurane-induced Malignant Hyperthermia and Its Attenuation by Cisatracurium in a Pre-clinical Porcine Model of Heart Transplant

Cao¹

2013

J Anesth Clin Res

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Background: Even after several years of study, the intra-operative diagnosis of Malignant Hyperthermia (MH) and the approach to anesthesia in MH-susceptible individuals has remained a challenge. In this study we present the pre-operative and intra-operative findings of development and progression of MH in a porcine model that was assigned for heart transplants. Methods:Female Yorkshire swine were assigned as either donor or recipient and anesthetized with inhalational isoflurane with or without cisatracurium. The inadvertent development of signs indicating MH, including, alterations required in ventilator/bypass machine settings, arterial and venous blood tests, gross-and histo-pathology, were followed through the surgeries that lasted for variable durations between donors and recipients.Results: Both donors and the recipients were apparently MH-susceptible, and showed systemic intraoperative signs of variable severity, that were greater in longer duration recipient surgeries, and in those in which cisatracurium was not administered. These included features of hypermetabolism such as elevated pCO 2 and serum lactate, increased requirements for O 2 (FIO 2 ), and multi-organ changes, including pulmonary congestion, features of intestinal pseudo-obstruction, and inflammatory infiltrates in livers and hearts. Conclusions:The isoflurane-induced MH progressed temporally in severity with the duration of surgery. Use of cisatracurium was directly beneficial in attenuating and/or delaying the progress of MH.

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“…[ 8 9 10 11 12 13 14 15 16 17 ] Of the 14 patients who experienced MH episodes, 10 were attributed to the use of volatile agents. [ 18 19 20 21 22 23 24 25 ] The triggering agent for the other 4 patients remained unknown, however, no known triggering anesthetic agents were used. [ 26 27 28 29 ]…”

Section: Discussionmentioning

confidence: 99%

“…[ 41 ] Similarly, exogenous heat during rewarming of the patient after hypothermic CPB may also trigger MH in MH-susceptible patients. [ 21 ] This has been demonstrated in a patient with a family history of MH who was cooled to a temperature of 32°C during CPB; MH was triggered within 1 hour postoperatively and was attributed to active rewarming. [ 29 ]…”

Section: Discussionmentioning

confidence: 99%

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Successful management of hypothermic cardiopulmonary bypass in a malignant hyperthermia susceptible patient

et al. 2020

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Malignant hyperthermia (MH) is a potentially lethal reaction in those that are genetically predisposed, frequently triggered by inhaled anesthetics. MH is often difficult to diagnose because it is accompanied by signs and symptoms that are shared with other disorders. The diagnosis is further obscured in cardiac surgical patients, as the signs of MH can be masked by the cardiopulmonary bypass circuit (CPB) and the use of induced hypothermia. In this case-report, we describe the successful anesthetic management of a 65-year-old MH-susceptible female, confirmed via caffeine halothane contracture test, with aortic regurgitation and ascending aortic dilatation who underwent a Bentall procedure. We have also identified certain key measures for the safe anesthetic management of these patients.

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Development of malignant hyperthermia during cardiopulmonary bypass

Cited by 10 publications

References 10 publications

Sevoflurane‐induced malignant hyperthermia during cardiopulmonary bypass and moderate hypothermia

Sevoflurane‐induced malignant hyperthermia during cardiopulmonary bypass and moderate hypothermia

The Progression of Isoflurane-induced Malignant Hyperthermia and Its Attenuation by Cisatracurium in a Pre-clinical Porcine Model of Heart Transplant

Successful management of hypothermic cardiopulmonary bypass in a malignant hyperthermia susceptible patient

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