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[Fulminant malignant hyperthermia during the 6th general anesthesia using volatile anesthetics]
H W Striebel1, J Lechner, C Wiegand
1Klinik für Anästhesiologie und operative Intensivmedizin, Klinikum Steglitz, Freie Universität Berlin.
Summary
A 30-year-old female experienced a severe malignant hyperthermia (MH) crisis during kidney transplant surgery. Prompt dantrolene treatment successfully managed the MH crisis, and subsequent testing confirmed MH susceptibility.
Area of Science:
- Anesthesiology
- Pharmacology
- Genetics
Background:
- Malignant hyperthermia (MH) is a rare, life-threatening pharmacogenetic disorder of skeletal muscle.
- Previous uneventful anesthesia does not preclude the possibility of a future MH crisis.
Observation:
- A 30-year-old female developed fulminant malignant hyperthermia during kidney transplantation under general anesthesia.
- Symptoms included rapid increases in end-tidal CO2, hyperkalemia, tachycardia, and hyperpyrexia.
Findings:
- Timely administration of dantrolene was critical in managing the acute MH crisis.
- An in vitro contracture test confirmed the patient's susceptibility to malignant hyperthermia.
Implications:
- This case highlights the importance of vigilance for MH even after prior uneventful anesthesias.
- Dantrolene remains the primary treatment for malignant hyperthermia, and its use under cover is crucial for subsequent procedures in susceptible patients.