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Malignant Hyperthermia: Report of Two Cases with a Neglected Complication in Cardiac Surgery

Mahdi Neshati1, Manizheh Azadeh2, Parinaz Neshati3

  • 1Department of Cardiothoracic Surgery, Ostad Aalinasab Hospital, Tabriz, Iran.

The Journal of Tehran Heart Center
|March 27, 2018
PubMed

Insights

Malignant hyperthermia (MH) is a rare but life-threatening reaction to anesthesia. Delayed diagnosis during cardiac surgery poses significant risks, leading to severe complications or death.

Area of Science:

  • Anesthesiology
  • Pharmacology
  • Critical Care Medicine

Background:

  • Malignant hyperthermia (MH) is a hypermetabolic crisis triggered by volatile anesthetics and succinylcholine.
  • Early diagnosis and treatment are crucial for survival, but diagnosis is challenging during cardiac surgery due to hypothermia and cardiopulmonary bypass.
  • This report details two challenging cases of MH in pediatric and adult cardiac surgery patients.

Observation:

  • Two patients, a 14-month-old infant and a 53-year-old male, developed MH post-cardiac surgery.
  • Symptoms included fever, hypotension, renal failure, and acidosis, with muscle spasms in one case.
  • MH was diagnosed late in the postoperative period, despite initial extubation.

Findings:

  • Both cases were graded as "very likely" or "almost certain" for MH.
  • Delayed MH diagnosis in the postoperative course led to permanent neurological damage in the infant and death in the adult patient.
  • The infant was discharged after two months of hospitalization.

Implications:

  • This highlights the critical need for heightened vigilance and prompt recognition of MH in cardiac surgery patients.
  • Improved diagnostic strategies and timely intervention are essential to prevent severe outcomes in MH.
  • Further research into early MH detection methods in complex surgical settings is warranted.
Keywords:
Cardiac surgical proceduresCardiopulmonary bypassMalignant hyperthermiaPostoperative care

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