[Malignant hyperthermia: multifactorial events leading to a crisis]

Area of Science:

• Anesthesiology
• Medical Genetics
• Trauma Surgery

Background:

• Malignant hyperthermia (MH) is a rare, life-threatening pharmacogenetic disorder of skeletal muscle.
• Anesthetic agents and succinylcholine are common triggers for MH crises.
• Trauma patients may present unique challenges for perioperative management.

Observation:

• A 21-year-old male trauma patient experienced a delayed malignant hyperthermia crisis 4 hours after surgery.
• The crisis was potentially triggered by multiple perioperative factors.
• Rapid genetic analysis was utilized for diagnosis, bypassing standard caffeine-halothane contracture testing.

Findings:

• The case highlights the possibility of delayed MH crisis onset in trauma patients.
• Genetic analysis provides a rapid diagnostic alternative to muscle biopsy for MH susceptibility.
• Multifactorial triggers may contribute to MH crisis development.

Implications:

• This case suggests a need for heightened vigilance for MH in trauma patients, even with delayed onset.
• Genetic testing should be considered for rapid MH diagnosis in critical care settings.
• An algorithm for managing potential MH crises in complex trauma cases is proposed.