Anesthetic management of a patient with neuroleptic malignant syndrome

Neuroleptic malignant syndrome is an uncommon, idiosyncratic, and sometimes life-threatening disorder associated with the use of neuroleptic drugs. The pathogenesis of neuroleptic malignant syndrome is uncertain, but it may be similar to that of malignant hyperthermia (MH). Some of the symptoms of neuroleptic malignant syndrome are similar to those of MH. We anesthetized a 17-year-old man with this syndrome multiple times for electroconvulsive therapy (ECT) using a variety of anesthetic techniques. In this patient, dantrolene pretreatment and the use of nondepolarizing muscle relaxants did not relieve symptoms of the syndrome, including fever and creatine phosphokinase (CPK) increases.