Markedly Delayed Postoperative Malignant Hyperthermia

Abstract

\s=b\ Malignant hyperthermia (MH) may be triggered by exposure to commonly employed anesthetic agents and muscle relaxants, and often manifests itself during the period of anesthesia. Delayedonset MH occurring one to four hours postoperatively has been described in isolated case reports. A case of delayedonset MH occurred 11 hours following routine tonsillectomy and adenoidectomy. The patient demonstrated tachypnea, tachycardia, hyperthermia, and metabolic acidosis. Prompt intravenous administration of dantrolene sodium was therapeutic. Serial serum creatine phosphokinase evaluation verified the diagnosis of MH. The implications of delayed-onset MH and the importance of preoperative screening for potentially susceptible individuals are discussed.

Safe Duration of Postoperative Monitoring for Malignant Hyperthermia Susceptible Patients

“…MH reactions can become apparent in PACU and, where trigger agents have been involved, all events with one exception 23 have developed within one hour of transfer to PACU [24][25][26][27] . Reported reactions following trigger-free anaesthesia are few and in general, mild [4][5][6][28][29][30][31][32][33] .…”

Anesthetic experience using total intra-venous anesthesia for a patient with Wolf-Hirschhorn syndrome -A case report-

“…The symptoms of the delayed type of malignant hyperthermia are tachypnea, tachycardia, hyperthermia and metabolic acidosis etc. [6]. But our patient showed all these symptoms of the delayed type of malignant hyperthermia except metabolic acidosis.…”

“…That was the first reported case in which the delayed type of malignant hyperthermia occurred in a WHS patient even following surgery. It has also been reported that the delayed type of malignant hyperthermia can occur even 11 hours after the completion of a surgical procedure [6]. …”

Safe Duration of Postoperative Monitoring for Malignant Hyperthermia Patients Administered Non-Triggering Anaesthesia: An Update

“…Improved anaesthetic and surgical techniques 14 have contributed to this policy, improving the cost-effectiveness of day-case surgery and limiting escalating healthcare costs. MH reactions in the postoperative period have been well described [15][16][17][18][19] . A review of the suspected cases of postoperative MH in the North American Malignant Hyperthermia Registry from 1987 to 2005 found that, of 528 possible cases, only ten were considered 'likely' MH reactions 18 .…”