Related Experiment Video
Updated: Jun 28, 2026
Esophageal Heat Transfer for Patient Temperature Control and Targeted Temperature Management
Published on: November 21, 2017
Malignant hyperthermia developing during esophageal resection in an 82-year-old man
Norihito Nakamura1, Tomomi Ueda, Reiri Ishikawa
1Department of Anesthesiology, Kawasaki Municipal Kawasaki Hospital, Kawasaki, Japan.
Abstract:
Malignant hyperthermia (MH) is a rare but fatal complication that develops under general anesthesia. Reports on MH in patients over the age of 80 years are unusual. We experienced a case of MH in an 82-year-old patient during esophageal resection. Anesthesia was induced with propofol and succinylcholine, and maintained with sevoflurane. Neither masseter spasm nor rigidity of the limbs was seen during induction. Body temperature (BT) at induction was 36.0 degrees C. Three hours after incision, the level of end-tidal CO2 was elevated to 55 mmHg. We assumed that the rise in end-tidal CO2 had occurred due to secretions in the airway. However, the BT, which had risen at 3 h after incision, continued to rise, and about 60 min later, the BT exceeded 39.0 degrees C. A rise of more than 0.5 degrees C in less than 15 min was seen, and MH was suspected. With dantrolene administration, the BT decreased from 40.9 degrees C at maximum to 37.7 degrees C. With continuous infusion of dantrolene when the patient was transferred to the intensive care unit (ICU), BT remained within the normal range. The next day re-operation was performed, without further complications or recurrence of MH during the postoperative period. Because it is necessary to initiate treatment in the early stage of MH, as soon as possible, although MH prevalence is low in the elderly, it is important to suspect MH when hypercapnia and/or hyperthermia are seen.
Insights
Malignant hyperthermia (MH), a rare anesthesia complication, occurred in an 82-year-old patient. Early recognition of hypercapnia and hyperthermia is crucial for prompt dantrolene treatment, even in the elderly.
Area of Science:
- Anesthesiology
- Pharmacology
Background:
- Malignant hyperthermia (MH) is a rare, life-threatening complication of general anesthesia.
- Elderly patients (over 80) are infrequently reported to develop MH.
Observation:
- An 82-year-old patient undergoing esophageal resection developed MH during sevoflurane anesthesia.
- Initial symptoms included unexplained hypercapnia, followed by rapid, severe hyperthermia exceeding 39.0°C.
- Masseter spasm and limb rigidity were absent during induction.
Findings:
- Prompt administration of dantrolene successfully reduced the patient's body temperature from a maximum of 40.9°C to 37.7°C.
- Continuous dantrolene infusion in the ICU prevented recurrence, allowing for successful re-operation the following day.
Implications:
- This case highlights the importance of suspecting MH in elderly patients presenting with hypercapnia and hyperthermia under anesthesia.
- Early diagnosis and immediate dantrolene treatment are critical for managing MH, regardless of patient age.
- Anesthesiologists should maintain a high index of suspicion for MH in older adults, despite its low prevalence.
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