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LETTER TO THE EDITOR

Can We Prevent Malignant Hyperthermia After Hypothermic Cardiopulmonary Bypass in a Malignant Hyperthermia-Susceptible Patient?

Department of Anesthesiology, Weill-Cornell Medical Center, New York, divemd{at}att.net (Lichtman) Cardiothoracic Intensive Care Unit, New York Methodist Hospital, Brooklyn, New York (Oribabor)

In Response:

We are gratified that our report (1) may have shed some new light on an unusual presentation of malignant hyperthermia (MH) in the case reported by Siddik-Sayyid et al. (2) However, the literature does not support the routine use of perioperative dantrolene in MH-susceptible patients. Hackl et al., 3 in their review of 30 anesthetics given to 24 in vitro, contracture, test-positive patients noted that none developed MH when given a nontriggering anesthetic. In fact, Allen and Cattran (4) reported that the postoperative pneumonia that developed in their MH-susceptible patient after dantrolene treatment was likely due to muscle weakness from the dantrolene itself. On the basis of these reports and others, we elected not to pretreat our patient with dantrolene. Also, given that MH may present in different ways and multiple anesthetics may be required before MH manifests itself, one cannot say for certain that any one technique or therapeutic addition prevented the development of MH in Siddik-Sayyid et al.’s patient. However, the fact that this patient did not develop MH from this anesthetic encounter we are sure was a great relief to the authors, and for that we offer well-deserved congratulations and job well done!

REFERENCES

1. Lichtman, AD, Oribabor C. Malignant hyperthermia following systemic rewarming after hypothermic cardiopulmonary bypass. Anesth Analg 2006;102:372–5.[Abstract/Free Full Text]
2. Siddik-Sayyid SM, Moussa AR, Baraka AS. Can we prevent malignant hyperthermia after hypothermic cardiopulmonary bypass in a malignant hyperthermia-susceptible patient? Anesth Analg 2007;104:214.[Free Full Text]
3. Hackl W, Mauritz W, Winkler M, et al. Anaesthesia in malignant hyperthermia-susceptible patients without dantrolene prophylaxis: a report of 30 cases. Acta Anaesthesiol Scand 1990;34:534–7.[Web of Science][Medline]
4. Allen GC, Cattran CB. Rewarming following hypothermic cardiopulmonary bypass in the malignant hyperthermia-susceptible patient: implications for diagnosis and perioperative management. Can J Anaesth 1989;36:81–5.[Web of Science][Medline]

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