[A Case of Suspected Delayed Postoperative Malignant Hyperthermia]

Area of Science:

• Anesthesiology
• Pharmacology
• Critical Care Medicine

Background:

• Severe acute cholecystitis with cholelethiasis necessitates emergency surgery.
• Patient presented with pre-existing fever and liver damage.
• Anesthesia involved propofol, fentanyl, sevoflurane, ropivacaine, and rocuronium.

Observation:

• Postoperative fever (40.6°C) and shock occurred 10 hours after laparoscopic cholecystectomy.
• The patient experienced two cardiac arrests, 20 and 42 hours post-surgery.
• Body temperature decreased following dantrolene administration.

Findings:

• The clinical presentation strongly suggested malignant hyperthermia.
• Dantrolene's efficacy in reducing fever supports the diagnosis of MH.
• The patient suffered hypoxic brain damage and required tracheostomy.

Implications:

• Postoperative fever and shock warrant consideration of malignant hyperthermia.
• Early recognition and treatment with dantrolene are crucial for MH management.
• This case underscores the critical need for vigilance in identifying MH post-anesthesia.