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¹St. Vincent Indianapolis Hospital, 2001 West 86th Street, Indianapolis, IN 46260, USA.

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|June 23, 2012

Summary

Rocuronium, a nondepolarizing neuromuscular blocker, may trigger malignant hyperthermia in susceptible patients. Discontinuation of rocuronium led to fever resolution in two reported cases, suggesting a potential link.

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Area of Science:

Anesthesiology
Pharmacology
Clinical Medicine

Background:

Malignant hyperthermia (MH) is a rare pharmacogenetic disorder often linked to anesthetic gases and depolarizing neuromuscular blockers.
Nondepolarizing neuromuscular blockers are generally considered safe for MH-susceptible patients, with limited reports suggesting a potential association.

Observation:

Two cases of delayed-onset malignant hyperthermia are presented in patients who received rocuronium, a nondepolarizing neuromuscular blocker.
One patient, a 27-year-old male, developed a fever 4 days after rocuronium infusion, reaching 105.2°F.
A 63-year-old male developed a fever of 107.1°F approximately 4 days after receiving rocuronium boluses and infusion.

Findings:

Rocuronium was suspected as the trigger for malignant hyperthermia in both patients, who had no prior history of the disorder.
Discontinuation of rocuronium therapy resulted in rapid fever reduction within 12-36 hours in both cases.
After evaluating other potential causes, rocuronium was identified as the most probable cause of the severe febrile response.

Implications:

These cases suggest a potential, albeit rare, association between rocuronium use and malignant hyperthermia.
Clinicians should consider malignant hyperthermia when unexplained fever occurs post-rocuronium administration, especially in critically ill patients.
Further investigation into the safety profile of nondepolarizing neuromuscular blockers in MH-susceptible individuals may be warranted.