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Delayed onset of sevoflurane-induced juvenile malignant hyperthermia after second exposure

Po-Liang Chen1, Yuan-Ji Day, Bai-Chuan Su

  • 1Department of Anesthesiology, Chang Gung Memorial Hospital, Linko, Taiwan, ROC.

Acta Anaesthesiologica Taiwanica : Official Journal of the Taiwan Society of Anesthesiologists
|November 2, 2007
PubMed

Insights

Malignant hyperthermia (MH), a rare anesthesia complication, can be triggered by sevoflurane, even with delayed onset. This case highlights the need for anesthesiologists to recognize atypical MH signs during routine practice.

Area of Science:

  • Anesthesiology
  • Pharmacology
  • Pediatrics

Background:

  • Malignant hyperthermia (MH) is a rare, life-threatening hypermetabolic response during anesthesia.
  • Sevoflurane is generally considered a low-risk trigger for MH, but cases suggest potential association with calcium release.
  • Delayed onset of MH is uncommon but possible, necessitating vigilance.

Purpose of the Study:

  • To report a rare case of delayed malignant hyperthermia (MH) triggered by sevoflurane.
  • To emphasize the atypical presentation of MH in a pediatric patient.
  • To alert anesthesiologists to the possibility of delayed MH with low-inducing agents.

Main Methods:

  • Case report of a 5-year-old boy undergoing repeat orthopedic surgery.
  • Administration of sevoflurane anesthesia for the second procedure within two days.
  • Monitoring for signs of MH, including heart rate, end-tidal carbon dioxide (EtCO2), and temperature.

Main Results:

  • Delayed MH onset occurred 90 minutes after sevoflurane induction during the second surgery.
  • Atypical signs included a gradually elevated heart rate, abrupt hypercarbia, and hyperthermia.
  • Prompt administration of dantrolene resulted in effective therapeutic response and patient recovery.

Conclusions:

  • Sevoflurane can induce delayed malignant hyperthermia, even with a low probability of triggering MH.
  • A gradually elevated heart rate may be an atypical sign of MH.
  • Anesthesiologists must remain alert for atypical MH presentations during routine anesthetic practice.

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