Malignant hyperthermia syndrome in an anxious patient

Area of Science:

• Anesthesiology
• Pharmacology
• Gastroenterology

Background:

• A 30-year-old patient with severe ulcerative colitis required multiple anesthetics for surgical procedures.
• Previous uneventful anesthesia with droperidol, fentanyl, and pancuronium was noted.

Observation:

• Subsequent anesthetics involving suxamethonium and nitrous oxide administration led to the manifestation of malignant hyperthermia (MH).
• The patient exhibited MH symptoms without developing hyperthermia, confirmed by muscle biopsy.

Findings:

• Malignant hyperthermia was successfully diagnosed via muscle biopsy in a patient with ulcerative colitis.
• The absence of hyperthermia during MH episodes is a notable clinical observation.

Implications:

• This case highlights the potential for MH to occur in patients with inflammatory bowel disease under specific anesthetic conditions.
• Preoperative patient anxiety may be a contributing factor to MH genesis, warranting further investigation.
• Anesthesiologists should consider MH risk in patients with ulcerative colitis, particularly when using triggering agents like suxamethonium and volatile anesthetics.