Malignant Hyperthermia in a Liver Transplant Patient: A Case Report

Fernandes, Cláudia Regina; Azevêdo, Danielle Maria Machado Ribeiro; Gomes, Jéssica Marcela de Luna; Gonçalves, Bronner P.; Coelho, Gustavo; Vasconcelos, J.B.M.; Garcia, José Huygens Parente

doi:10.1016/j.transproceed.2007.09.036

Cited by 15 publications

(22 citation statements)

References 14 publications

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“…Because this syndrome present with nonspecifi c signs and treatment delay results in life-threatening outcome, this drug should be administered as soon as MH is suspected. However, dantrolene does not come without its complications -hepatotoxicity is one of its potential adverse effects 15,24 . In an analysis of 368 patients who received dantrolene for MH treatment, the most frequent complications were muscle weakness (21.7%), phlebitis (9%), gastrointestinal discomfort (4.1%), and respiratory failure (3.8 %) 25 .…”

Section: Case Reportmentioning

confidence: 99%

“…Mutation in RYR1 is found in approximately 50% of the susceptible families [11][12][13] . The occurrence of MH is seen in the fi rst or in subsequent exposures to halogenated agents 14,15 . Currently, dantrolene remains the primary basis for the successful management of MH 16,17. The syndrome recrudescence may occur in up to 20% of cases, mostly within 16 hours of the clinical condition onset 18 .…”

Section: Introductionmentioning

confidence: 99%

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Recrudescência fatal de hipertermia maligna em lactente com síndrome de Moebius. Relato de caso

Fernandes¹,

Filho²,

Cezar³

et al. 2013

Rev. Bras. Anestesiol.

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Background and objectives: Malignant hyperthermia (MH) is a pharmacogenetic skeletal muscle disorder characterized by a hypermetabolic state after anesthesia with succinylcholine and/ or volatile anesthetics. Various neuromuscular syndromes are associated with susceptibility; however, Moebius syndrome has not been reported. Dantrolene is the drug of choice for treatment. Recurrence may occur in up to 20% of cases after the initial event treatment. Case Report: Male infant, fi rst twin, 7 months old, weighing 6.5 kg and presenting with Moebius syndrome was admitted for clubfoot repair. The patient had MH after exposure to sevofl urane and succinylcholine, which was readily reversed with dantrolene maintained for 24 hours. Ten hours after dantrolene discontinuation, there was recrudescence of MH that did not respond satisfactorily to treatment, and the patient died. Discussion: Musculoskeletal disorders in children are associated with increased risk of developing MH, although Moebius syndrome has not yet been reported. Dantrolene is the drug of choice for treating this syndrome; prophylaxis is indicated during the fi rst 24-48 hours of the episode onset. The main risk factors for recurrence are muscular type, long latency after anesthetic exposure, and increased temperature. The child had only one risk factor. This case leads us to refl ect on how we must be attentive to children with musculoskeletal disease and maintain treatment for 48 hours.

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Section: Case Reportmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Recrudescência fatal de hipertermia maligna em lactente com síndrome de Moebius. Relato de caso

Fernandes¹,

Filho²,

Cezar³

et al. 2013

Rev. Bras. Anestesiol.

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“…Furthermore, the depolarizing muscle relaxant succinylcholine triggers the syndrome 49 . Isoflurane, desflurane and sevoflurane appear to be less potent triggers than halothane, but these agents can produce a more gradual or fast onset of MH [50][51][52][53][54][55][56] . The onset may be explosive if succinylcholine is used 57 .…”

Section: Triggering Agentsmentioning

confidence: 99%

“…In the two available reports of the use of dantrolene sodium during liver transplantation, there were alterations in postoperative laboratory exams, but the liver graft recovered uneventfully 56,96 . Actually, although dantrolene may pose an additive threat in the large set of perioperative injuries to the graft, abnormal symptoms and laboratory exams may be masked in the routine postoperative course of hepatic transplantation.…”

Section: Side Effectsmentioning

confidence: 99%

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Malignant Hyperthermia in Liver Transplantation

Fernandes¹,

Marinho²,

Cavalcante³

2012

Liver Transplantation - Basic Issues

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Simultaneous malignant hyperthermia reactions in two siblings during living donor liver transplantation

Majeed

Chiah

Latif³

et al. 2022

Anaesthesia Reports

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Summary We report a case of simultaneous malignant hyperthermia reactions occurring in two siblings during living donor liver transplantation. This report highlights the conflicting goals in the clinical management of liver transplantation and malignant hyperthermia, including the use of total intravenous anaesthesia and dantrolene in the face of the potential for drug‐induced hepatotoxicity in the remnant liver or transplanted liver graft, as well as cautious fluid management needed for liver transplantation balanced against the liberal fluid therapy required to prevent acute kidney injury associated with malignant hyperthermia. The logistical challenges of managing this emergency in two closely related patients are discussed, including rapid preparation of two vapour‐free anaesthesia machines, the need for availability of additional dantrolene and the requirement for additional personnel. Prompt recognition, immediate removal of the triggering agents and conversion to total intravenous anaesthesia helped to curtail the malignant hyperthermic reactions in our patients, both of whom made a full recovery.

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Malignant Hyperthermia in a Liver Transplant Patient: A Case Report

Cited by 15 publications

References 14 publications

Recrudescência fatal de hipertermia maligna em lactente com síndrome de Moebius. Relato de caso

Recrudescência fatal de hipertermia maligna em lactente com síndrome de Moebius. Relato de caso

Malignant Hyperthermia in Liver Transplantation

Simultaneous malignant hyperthermia reactions in two siblings during living donor liver transplantation

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