The Importance of Early Recognition and Management in Patients with Suspect of Malignant Hyperthermia: Case Report

Background: Malignant hyperthermia (MH) is a rare pharmacogenetic syndrome characterized by a severe hypermetabolic reaction after the administration of several halogenated inhalational anesthetics or depolarizing muscle relaxants such as succinylcholine, or both. MH is related to the exacerbated release of calcium in the myoplasm causing rhabdomyolysis. This case describes a rapid onset MH (15 minutes) after induction and intubation of general anesthesia.

Case Report: Male, 30 years old, 85 kg, 76 cm tall and 119 kg, admitted with pancreatitis, to undergo endoscopic retrograde cholangiopancreatography and passage of a biliary prosthesis. Anesthetic induction with 200 μg of fentanyl, 80 mg of lidocaine without vasoconstrictor, 200 mg of propofol, 100 mg of succinylcholine and sevoflurane. Fifteen minutes tachycardia, hypoxemia, increased EtCO2, muscle stiffness. MH diagnostic hypothesis, arterial blood was collected, the entire respiratory system was changed, dantrolene and an ice pack were started. Gradual improvement, he was sent to the ICU where he remained for three days, being extubated on the 2nd day, discharged to the 4th to the ICU, and hospital discharge on the 5th day.

Conclusion: This case showed the MH with rapid diagnosis and despite being a potentially fatal disease, the rapid administration of dantrolene, together with maintenance doses, clinical control of symptoms, allowed a favorable outcome, with hospital discharge on 5th postoperative day. The patient refused to undergo genetic testing and that of family members.

Keywords: Inhalational Anesthetics, Malignant Hyperthermia, Dantrolene, Anesthetic Complications.