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GENERAL ARTICLES

A Suspected Case of Delayed Onset Malignant Hyperthermia with Desflurane Anesthesia

Department of Anesthesiology, Medical College of Ohio, St. Luke’s Hospital Heart Center, Maumee

Address correspondence and reprint requests to Thomas J. Papadimos, MD, 7162 Copperwood Lane, Sylvania, Ohio 43560. Address e-mail to TPapadimos{at}mac.com

Desflurane has been identified as a weak triggering anesthetic of malignant hyperthermia that, in the absence of succinylcholine, may produce a delayed onset of symptoms. The prolonged interval after exposure may occur more than 6 h after the induction of anesthesia. The unintended underdosing of this patient with dantrolene and the prompt reversal of symptoms may be an attribute of the genetic expression of a weak triggering volatile anesthetic such as desflurane.

IMPLICATIONS: There are multiple genetic variations for malignant hyperthermia (MH) at the ryanodine receptor. Desflurane, as a sole trigger of MH, is weak, and on two occasions in the literature (including this case), less than optimal doses of dantrolene were given with a good result. There may be possible to engineer the risk of MH out of an anesthetic once the genetics of the ryanodine receptor are better understood.

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