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Malignant hyperpyrexia and isoflurane. A case report.

D W Thomas1, V J Dev, M J Whitehead

  • 1Department of Anaesthetics, Morriston Hospital, Cwmrhydyceirw, Swansea.

British Journal of Anaesthesia
|September 1, 1987
PubMed
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Malignant hyperpyrexia was successfully treated in a patient during pyelolithotomy. Early diagnosis using end-tidal carbon dioxide monitoring and prompt i.v. dantrolene administration were key to successful management.

Area of Science:

  • Anesthesiology
  • Pharmacology
  • Surgical Complications

Background:

  • Malignant hyperpyrexia (MH) is a rare, life-threatening pharmacogenetic disorder of skeletal muscle.
  • Triggering agents, primarily volatile anesthetics and succinylcholine, can induce MH in susceptible individuals.
  • Pyelolithotomy is a surgical procedure to remove kidney stones.

Observation:

  • A 50-year-old male patient developed malignant hyperpyrexia during pyelolithotomy.
  • End-tidal carbon dioxide monitoring indicated a rapid increase, suggesting a hypermetabolic state.
  • The patient received intravenous dantrolene for treatment.

Findings:

  • The patient's malignant hyperpyrexia was successfully treated with i.v. dantrolene.
  • A subsequent muscle biopsy confirmed the diagnosis of malignant hyperpyrexia.

Related Experiment Videos

  • Isoflurane was identified as the most probable triggering agent in this case.

    • Implications:

    • Early detection of malignant hyperpyrexia through capnography is crucial for timely intervention.
    • Intravenous dantrolene remains the primary pharmacologic treatment for malignant hyperpyrexia.
    • This case highlights the importance of recognizing potential triggers like isoflurane in susceptible patients.