This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Choiniere, A. Search for Related Content PubMed PubMed Citation Articles by Choiniere, A.

---

LETTER TO THE EDITOR

Could This Be Malignant Hyperthermia?

Department of Anesthesiology; Verdun Hospital; Montreal, Canada; andre_choiniere{at}yahoo.ca

To the Editor:

I was surprised that the possibility of a malignant hyperthermia (MH) crisis was not considered in the management of the recent case report by Phadke et al.1 After induction of general anesthesia with propofol, intubation with rocuronium and maintenance with sevoflurane, this patient developed hypercapnia not responsive to hyperventilation and tachycardia. In the postoperative period, he developed progressive metabolic acidosis, hyperthermia, acute renal failure with anuria, a coagulopathy, and focal seizure activity. Postmortem examination revealed rhabdomyolysis. Muscle rigidity was not reported, but it is not always present during a MH crisis. The fact that this patient had undergone eight previous surgical procedures under general anesthesia without complications doesn't rule out MH; patients with MH may have multiple event free exposures to triggering agents before suffering a MH crisis.2 Did the neonatal team consider MH? If so, they should have started Dantrolene therapy.

The possibility of Duchenne's Muscular Dystrophy raised by the family should have increased even further suspicions of MH since the incidence of MH is increased in patients with Duchenne's Muscular Dystrophy,2 and a halothane and caffeine contracture test should have been done to rule out MH.

There was a missed opportunity here, and the implications for other family members could be important since they may also be susceptible to MH and be at risk if exposed to triggering agents in the future.

REFERENCES

1. Phadke A, Broadman LM, Brandom BW, Ozolek J, Davis PJ. Postoperative hyperthermia, rhabdomyolysis, critical temperature, and death in a former premature infant after his ninth general anesthetic. Anesth Analg 2007;105:977–80[Abstract/Free Full Text]
2. Stoelting RK, Dierdorf SF. Diseases presenting in pediatric patients. In: Anesthesia and Co-Existing Disease. 4th ed. New York: Churchill Livingstone, 2002;716–21

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Choiniere, A. Search for Related Content PubMed PubMed Citation Articles by Choiniere, A.