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

“…Rhabdomyolysis may be an underestimated entity that occurs as a primary disease or as a complication of MH susceptibility. The Malignant Hyperthermia Association of the United States suggests that one person in 200 may be at risk, with a mortality rate as high as 20% in those individuals who actually develop the syndrome (10). Those patients surviving a MH crisis frequently develop brain damage, renal failure, paralysis, and other major organ impairments.…”

“…Those patients surviving a MH crisis frequently develop brain damage, renal failure, paralysis, and other major organ impairments. Because of its rapid onset, MH can create a life-threatening situation in minutes unless the condition is promptly recognized and treated (10).…”

“…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).…”

“…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).…”