A Malignant Hyperthermialike Episode in a Liver Transplant Recipient

Tsujikawa, Hiroshi; Segawa, Hajime; Fukuda, Kazuhiko

doi:10.6002/ect.2012.0261

Cited by 1 publication

(1 citation statement)

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“…A nontriggering anesthetic using TIVA with propofol and sufentanil infusions provided hemodynamic stability in this critically ill individual. Very few previous cases have described MH-susceptible patients undergoing OLTx and the majority of these involved intraoperative triggering in a previously unknown MH-sensitive patient necessitating the switch to TIVA during the procedure [ 3 – 5 ]. The only other case in which MH history was known prior to OLTx occurred in 1998 and the choice of anesthetic agents included continuous midazolam and fentanyl infusions [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

Orthotopic Liver Transplantation in a Patient with Acutely Decompensated Liver Disease and Personal History of Malignant Hyperthermia

Townsend

Habibi

Groose

et al. 2022

Case Reports in Anesthesiology

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Introduction Orthotopic liver transplants are characterized by sudden changes in hemodynamics, intraoperative hemorrhage, metabolic and electrolyte derangements, and arrhythmias. Many of these features are also hallmarks of malignant hyperthermia episodes and make differentiation difficult intraoperatively. Additionally, the treatment for malignant hyperthermia, dantrolene, can cause hepatotoxicity in already damaged native livers and newly reperfused organ allografts. Thus, it is imperative to avoid a triggering anesthetic in these patients. Here we report on a successful total intravenous anesthetic in a malignant hyperthermia susceptible individual undergoing an orthotopic liver transplant for acutely decompensated end-stage liver disease. Case Presentation . A 49-year-old male with a past medical history significant for malignant hyperthermia episodes as a child was admitted with decompensated alcoholic cirrhosis. He underwent uneventful total intravenous general anesthesia with propofol and sufentanil continuous infusions for an orthotopic liver transplant. He required minimal vasoactive agents to maintain a mean arterial blood pressure >65 mmHg and was extubated on postoperative day 1. Conclusions Total intravenous anesthesia is necessary for patients with a personal history of malignant hyperthermia. However, this type of general anesthesia is difficult in the setting of fluctuating hemodynamics, hemorrhage, and changes in drug metabolism and clearance during the anhepatic and reperfusion phases of an orthotopic liver transplant. Propofol and sufentanil continuous infusions provided stable hemodynamics and an excellent plane of anesthesia throughout the case and should be considered in other individuals undergoing this procedure who require a total intravenous anesthetic.

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Section: Discussionmentioning

confidence: 99%