Differential diagnosis of malignant hyperthermia: a case report

A 17-year-old male received general anesthesia for repair of a torn right knee anterior cruciate ligament. The medical history revealed manic-depressive psychosis, treated with lithium carbonate and sertraline hydrochloride, and asthma for which the patient occasionally used an albuterol inhaler. Induction with propofol, isoflurane, nitrous oxide, and oxygen was uneventful. Anesthesia was maintained by isoflurane, nitrous oxide, and oxygen. During the first 90 minutes after induction, a persistent mild elevation in end-tidal carbon dioxide was noted, and several possible causes for this elevation were subsequently ruled out. A diagnosis of malignant hyperthermia was made when the patient exhibited tachycardia and a temperature increase, although some discussion remained regarding the possibility of neuroleptic malignant syndrome. The patient was treated successfully using a malignant hyperthermia protocol. Malignant hyperthermia may prove fatal if effective treatment is delayed. Favorable outcome and patient prognosis rely on astute vigilance, accurate diagnosis, and swift, appropriate treatment.