Malignant Hyperthermia

Successful Use of Cardiopulmonary Bypass and Ultrafiltration for Metabolic Resuscitation of a Moribund Child With Acute Perianesthetic Rhabdomyolysis: A Case Report of Unsuspected Malignant Hyperthermia

“…The accelerating acidosis increases membrane permeability and rhabdomyolysis, which causes increased levels of serum calcium, potassium, CK, and myoglobin. Elevated temperature, which may or may not be present, is considered a late sign of MH, as are electrolyte abnormalities, myoglobinuria, coagulopathy, and acute pulmonary edema (9). In this case, the clinical factors consistent with MH were a reaction to succinylcholine, hyperkalemic cardiac arrest, masseter spasm, myoglobinuria and renal failure, elevated CK, respiratory and metabolic acidosis, pulmonary edema, hypoxia, and coagulopathy.…”

“…The typical patient at risk for MH is young, muscular, usually male, and caucasian (10). The patient's history may include reports of intolerance to anesthetics, localized muscular weakness or cramps, joint hypermobility, orthopedic abnormalities such as spinal curvatures, or a disease such as Duchenne's muscular dystrophy (7,9,10). In addition to its recognition for MH susceptibility, Duchenne's muscular dystrophy has also been known to increase a patient's cardiac risk from general anesthesia because of difficult-to-resuscitate cardiac arrest, muscular rigidity, and acute rhabdomyolysis of skeletal muscles (7).…”

“…However, the clinical picture becomes obscured by the fact that MH can be highly variable and present with some or all of the many symptoms of the disorder (8) When family history is either unknown or incomplete, it is inevitable that MH-susceptible patients will be anesthetized with triggering agents. When recognized early, the resultant crises can usually be managed by immediate cessation of all inhalation anesthetics and/or muscle relaxants, assisted ventilation with 100% oxygen, provision of symptomatic relief of early and late complications, and the administration of the drug dantrolene, which prevents the release of calcium into skeletal muscle myoplasm, helping to avert the crisis precipitated by continuous muscle contractions (9,10).…”