Delayed Onset Malignant Hyperthermia after Sevoflurane

Abstract

Malignant hyperthermia is a hypermetabolic response to inhalation agents (such as halothane, sevoflurane, and desflurane), succinylcholine, vigorous exercise, and heat. Reactions develop more frequently in males than females (2 : 1). The classical signs of malignant hyperthermia are hyperthermia, tachycardia, tachypnea, increased carbon dioxide production, increased oxygen consumption, acidosis, muscle rigidity and rhabdomyolysis. In this case report, we present a case of delayed onset malignant hyperthermia-like reaction after the second exposure to sevoflurane.

The Changing Face of Malignant Hyperthermia: Less Fulminant, More Insidious

“…Because of the slow onset of the signs, a presumptive diagnosis of MH was only considered after two hours of anaesthesia and for some time even felt to be an argument against MH by the attending anaesthetist. This pattern is more common than generally assumed, as evidenced by several similar reports over the last few years [6][7][8][9][10][11] . Regarding the more 'indolent character' of MH, a recent paper provides, for the first time, statistical evidence that the MH median onset time was significantly shorter for the cases that occurred before 1998, compared to the cases that occurred later 12 .…”

Successful early application of extracorporeal membrane oxygenation to support cardiopulmonary resuscitation for a patient suffering from severe malignant hyperthermia and cardiac arrest: a case report

“…The vaporizer used for administration of volatile anesthesia should be removed from the anesthesia machine and the patient should be hyperventilated with 100% oxygen at a maximum fresh gas flow, increasing the minute volume by approximately 2–3 fold, while aiming for an ETCO 2 within the normal limits [ 3 ]. The gold standard for diagnosis of MH susceptibility is the caffeine-halothane contracture test [ 5 ]. But DNA analysis, requiring only a blood sample, could be an alternative to this invasive test [ 7 ].…”

“…But DNA analysis, requiring only a blood sample, could be an alternative to this invasive test [ 7 ]. However, as this test is not widely available, the diagnosis of MH can be made by clinical presentation in most cases [ 5 ]. Therefore, we diagnosed MH based on clinical symptoms and the clinical symptom ceased on dantrolene administration.…”

“…Dantrolene sodium is a specific antagonist of the pathophysiologic changes initiated by MH and is a life-saving drug when administered in the earlier stages [ 5 ]. After the introduction of dantrolene sodium, a causative treatment became available [ 6 ], and the mortality rate for acute MH crisis decreased from approximately 70–80% to about 5% [ 7 ].…”

Administration of Anaesthetic Triggering Agents to Patients Tested Malignant Hyperthermia Normal and Their Relatives in New Zealand: An Update

“…Induction to onset time in 75 MH episodes documented in New Zealand averaged 48 minutes (unpublished data, N Pollock); the average anaesthetic exposure in this study was 45 minutes, which should have been sufficient exposure to trigger an MH episode in the majority of patients. In view of reports of delayed presentation of MH episodes [15][16][17][18] , and as there are reports of MH episodes becoming manifest following termination of anaesthesia, PACU recordings are documented in the present study. Litman reviewed 528 suspected MH episodes contained in the North American MH Registry.…”