An Unusual Case of Malignant Hyperthermia During Desflurane Anesthesia in an African-American Patient

Abstract

Malignant hyperthermia is an uncommon, heritable condition triggered by anesthesia and is followed by an increase in temperature that may be fatal without prompt treatment. It is rare with desflurane and in black individuals of African descent. We present a case of malignant hyperthermia in an African-American patient during desflurane anesthesia.

A Suspected Case of Delayed Onset Malignant Hyperthermia with Desflurane Anesthesia

“…Further work by Allen and Brubaker (4) indicated that presentation of MH with desflurane use (without succinylcholine) may be delayed (53-380 minutes), and they also suggest that desflurane is a weak trigger. Several case reports are in agreement that, without succinylcholine exposure, desflurane causes delayed-onset MH (3,5,6).…”

“…It is characterized by hyperthermia, tachycardia, acidosis, and muscle rigidity (1). Several reports indicate that MH symptoms can become manifest after a prolonged exposure interval when desflurane is the only trigger (2)(3)(4)(5)(6). We report a case of suspected delayed onset MH during thoracotomy in which desflurane was the sole trigger.…”

Delayed-onset malignant hyperthermia in association with rocuronium use

“…[10][11][12][13] Polta et al 10 described the development of isolated masseter-muscle spasm-a common finding in patients experiencing malignant hyperthermia and a risk factor for the development of the disorder-after the administration of pancuronium in a 20-year-old man undergoing corrective surgery for congenital aortic stenosis 2,10 ; he received pancuronium a second time during orotracheal intubation and experienced a recurrence of the rigidity of the jaw muscles. The patient recovered fully without treatment in both instances.…”

“…This presentation has only been suggested in one other reported case, that of a 28-year-old man who received fentanyl, midazolam, rocuronium, nitrous oxide, and desflurane in preparation for maxillofacial surgery after a motor vehicle accident. 13 Seven hours after anesthesia induction, the patient was noted to have an elevated end tidal carbon dioxide concentration and an increased temperature. The patient was determined to have malignant hyperthermia, so surgery was not performed, desflurane was discontinued, the carbon dioxide canisters and anesthesia machinery were changed, a cooling blanket was applied, and dantrolene, cold i.v.…”

“…The occurrence of malignant hyperthermia with the administration of either benzylisoquinolinium or aminosteroidal nondepolarizing neuromuscular blockers is not well established. [10][11][12][13] Therefore, the use of nondepolarizing neuromuscular blockers, particularly aminosteroidal neuromuscular blockers such as rocuronium, is generally considered safe in patients at risk for malignant hyperthermia. [1][2][3]6,14 Here we describe two patients in whom rocuronium was the most likely trigger for the development of malignant hyperthermia.…”