Diagnostic Challenges in Malignant Hyperthermia and Anesthesia-Induced Rhabdomyolysis: A Case Study

Area of Science:

• Anesthesiology
• Pharmacogenomics
• Critical Care Medicine

Background:

• Malignant hyperthermia (MH) and anesthesia-induced rhabdomyolysis (AIR) are rare, life-threatening complications of general anesthesia.
• Both conditions share overlapping clinical manifestations including hypermetabolism, hyperpyrexia, and hypercarbia, complicating diagnosis and treatment.
• While MH is an inherited pharmacogenomic disorder, AIR is often associated with muscular dystrophies, though rhabdomyolysis can occur in other critical conditions.

Observation:

• A challenging case involving general anesthesia for onco-surgery in a patient with difficult airways and simultaneous intraoperative irradiation.
• The patient presented with mild hypercarbia and protracted rhabdomyolysis, but without hyperpyrexia, leading to diagnostic uncertainty between MH and AIR.
• Dantrolene was withheld due to diagnostic ambiguity, and the patient received successful supportive treatment.

Findings:

• The clinical presentation of MH and AIR can be atypical, making prompt diagnosis difficult.
• Genetic testing is crucial for differentiating between MH and AIR when clinical presentation is inconclusive.
• Supportive care can be effective in managing these rare anesthetic complications when dantrolene is not indicated.

Implications:

• This case underscores the diagnostic dilemma between MH and AIR in perioperative settings.
• It emphasizes the need for considering preoperative preventive strategies and alternative treatment options for patients with uncertain diagnoses.
• Further research into differentiating these conditions and optimizing management protocols is warranted.