Identificación y tratamiento oportuno exitoso de hipertermia maligna

Abstract

Malignant hyperthermia (MH) is an acute hypermetabolic pharmacogenetic syndrome triggered by succinylcholine and inhaled anesthetics; the prevalence of MH episodes ranges from 1:10,000 to 1:220,000 cases per administered anesthesia; there is a deregulation in intracellular calcium homeostasis generating muscle rigidity, high energy expenditure, increased VO 2 , without timely treatment mortality is greater than 65% due to rhabdomyolysis, hyperkalaemia, increased CPK and multiple organ failure, with treatment specific decreases to 10%. We report the first case of malignant hyperthermia in preschool with extubation and early hospital discharge after the crisis; It is a 2-year-old female with no previous history diagnosed with syndactyly since birth. She is scheduled for correction of congenital deformity. She is performed under a balanced general anesthetic technique with sevoflorane and remifentanil. At the second hour of surgery, she presents symptoms compatible with malignant hyperthermia (tachycardia). , hypercapnia, hyperthermia) treatment was started according to the SCARE protocol with maintenance doses of dantrolene for 24 h, extubation at 24 h and discharge on the third day with follow-up in an outpatient clinic without sequelae. This case report highlights the importance of timely recognition of malignant hyperthermia crisis, the early initiation of pharmacological and non-pharmacological treatment during and after the crisis, the use of cognitive aids such as SCARE crisis protocols and the training of health personnel as a determining factor of the morbidity and mortality of these patients.