Delayed-onset malignant hyperthermia in association with rocuronium use

Cisatracurium-Associated Malignant Hyperthermia During Severe Sars-CoV-2 Infection

“…When it comes to muscle relaxants, existing literature indicates that MH is mostly triggered by the depolarizing neuromuscular blocker succinylcholine; however, there have been rare case reports of nondepolarizing NM blockers causing MH. 4,5 There has only been one report of cisatracurium-induced MH reported before. 5 Interestingly both cases had acute respiratory distress syndrome raising suspicion for a possible association between MH and cisatracurium in patients with acute respiratory distress syndrome.…”

“…MH may occur any time after administration of the triggering agent, but most commonly it is seen within 140 minutes after halogenated anesthetics and within 35 minutes after succinylcholine. 4 Most of the cases occur in the intraoperative or postoperative setting after administration of these agents. When it comes to muscle relaxants, existing literature indicates that MH is mostly triggered by the depolarizing neuromuscular blocker succinylcholine; however, there have been rare case reports of nondepolarizing NM blockers causing MH.…”

Malignant Hyperthermia and Cisatracurium During Severe SARS-CoV-2 Infection

“…7 Two case reports cited by the authors reported that rocuronium caused hyperthermia (105.2°F and 107.1°F) approximately 4 days after rocuronium infusion, and cisatracurium infusion caused hyperthermia (106°F) a few hours after cessation of cisatracurium with 48 hours infusion. 8,9 Cisatracurium caused high fever (106.6°F) 16 hours after cisatracurium administration in this case. 1 Although malignant hyperthermia occurs anytime during anesthesia, similar to previous reports, this hyperthermia seems to have had a delayed onset.…”

“…1 Although malignant hyperthermia occurs anytime during anesthesia, similar to previous reports, this hyperthermia seems to have had a delayed onset. 1,8,9 In addition, severe acute respiratory syndrome coronavirus-2–induced ARDS of this patient may partially contribute to respiratory symptom. 1 Thus, although cooling, cessation of cisatracurium infusion, and intravenous administration of dantrolene relieved fever and improved arterial blood gas analysis, taking into consideration the above mentioned factors, the hyperthermia observed in this patient may be due to other causes rather than cisatracurium.…”

Reacciones adversas inmunitarias y no inmunitarias a fármacos de uso perioperatorio

“…La hipertermia maligna es un desorden farmacogenético que puede ocurrir en al menos 1 de 3000 procedimientos anestésicos y se ha asociado con el uso de los agentes bloqueantes neuromuscu-lares despolarizantes (por ejemplo, succinilcolina), sin embargo, se ha descrito la instauración tardía de hipertermia maligna en pacientes que han recibido el anestésico rocuronio, agente bloqueante neuromuscular no despolarizante. 18 Diagnóstico La historia clínica y su relación con el agente causal 19 es muy importante para el diagnóstico, se debe defi nir el tiempo de aplicación del fármaco y la aparición de los síntomas. 7 Además, pruebas específi cas pueden ser útiles, entre ellas se encuentra la determinación de la IgE específi ca, estimando una sensibilidad de 83 a 92 % para el rocuronio, 78 a 84 % para la morfi na y 44 % para el suxametonio.…”