Introduction and Importance
Malignant hyperthermia (MH) is a hypermetabolic reaction caused by exposure to halogenated volatile anesthetics or succinylcholine. Symptoms include unexplained elevations in end-tidal carbon dioxide and body temperature, muscle rigidity, hemodynamic instability, and electrolyte disturbances. Delayed diagnosis and treatment end up with detrimental consequences.
Case presentation
A 19-year-old healthy patient with a negative surgical history for anesthesia complications presented for an elective otolaryngology surgery. Following a smooth induction of general anesthesia and while maintained on sevoflurane, the patient started having elevation in end-tidal carbon dioxide and body temperature followed by hemodynamic instability. MH reaction was suspected. Dantrolene was directly administered intravenously along with cold physiologic saline. Consequently, body temperature as well as end tidal CO2 gradually decreased; the patient improved hemodynamically. The surgery was completed, and the patient was transferred to the intensive care unit for continuity of care.
Clinical discussion
MH is challenging for both anesthesia and surgical teams as well as for hospitals in general. Although symptoms are non-specific, the diagnosis of MH reaction and the subsequent initiation of treatment with dantrolene should be prompt. As such, hospitals should be logistically prepared for such scenarios. Furthermore, the treating medical team should be trained in advance in order to avoid any possible delay that might result in catastrophic consequences on the patient.
Conclusion
Early recognition and initiation of treatment are important for survival in MH. This can be achieved by proper staff education along with logistical preparedness.
Highlights
