A case report of suspected malignant hyperthermia where patient survived the episode

Abstract

Malignant hyperthermia is rare inherited disorder in our part of the world; there are only few cases reported in literature in India who were suspected of having this condition. The overall incidence of malignant hyperthermia during general anesthesia is estimated to range from 1: 5000 to 1: 50,000–100,000 and mortality rate is estimated to be <5% in the presence of standard care. In India, there is no center where in vitro halothane caffeine contraction test is performed to confirm diagnosis in suspected cases. Second, dantrolene drug of choice for this condition is not freely available in market in India and is stored only in some hospitals in few major cities. Among the cases reported of suspected of malignant hyperthermia in India almost 50% have survived the condition despite nonavailability of dantrolene emphasizing role of early detection and aggressive management in these cases.

Malignant Hyperthermia in Bariatric Surgery: A Case Study With Clinical, Pathophysiological, Biochemical and Biophysical Correlations

“…Constant muscle contraction causes a decrease in ATP levels and consequent difficulty in muscle relaxation, which explains the masseter rigidity presented by patients during the MH crisis [ 5 , 6 , 13 , 28 ]. The patient L.R.M.S.…”

“…Late addition of dantrolene is also reported in intra- and postoperative MH cases with different results, and some were fatal, while others had no additional complications [ 2 , 45 , 53 , 54 ]. On the other hand, there were related intra- [ 28 , 55 ] and postoperative [ 54 ] MH cases in which dantrolene was not administrated due to non-availability of the drug in the hospital. Iqbal et al (2017) [ 28 ] reported the clinical signs and laboratory parameters altered by the MH crisis were reversed with internal (ice cold saline intravenously) and external (ice packs and cold towels over the body) cooling, and the patient had full recovery before being discharged.…”

“…On the other hand, there were related intra- [ 28 , 55 ] and postoperative [ 54 ] MH cases in which dantrolene was not administrated due to non-availability of the drug in the hospital. Iqbal et al (2017) [ 28 ] reported the clinical signs and laboratory parameters altered by the MH crisis were reversed with internal (ice cold saline intravenously) and external (ice packs and cold towels over the body) cooling, and the patient had full recovery before being discharged. Pan et al (2016) [ 54 ], in the case report III, described that the inhalation anesthetic was not used in the operation, but the body temperature rose slowly during the postoperative period and, after 2 days, the patient was in critical condition.…”

Dengue Fever-Triggered Malignant Hyperthermia

“…A clinical grading system (CGS) can be used to assess the likelihood of MH based on a scoring system. According to this system, a patient with a score of >50 points has malignant hyperthermia [ 5 , 6 ]. The scoring system helps to identify acute crises in patients who have not been previously recognized as malignant hyperthermia-susceptible individuals or in situations where genetic or in vitro contracture testing is not possible.…”

Difficult airway management and suspected malignant hyperthermia in a child with Cri Du Chat syndrome

“…However, patients have been shown to survive MH episodes even in the absence of dantrolene provided the diagnosis is considered early enough, and aggressive symptomatic treatment is carried out. [ 6 ] We were unable to confirm a definite diagnosis of MH because of unavailability of the “gold standard” confirmatory in vitro contracture test[ 4 ] however, pending future confirmatory studies it would be prudent to consider patients with CdCs as susceptible to MH and treated as such.…”