Malignant Hyperthermia Successful Treatment with Dantrolene: a Case Report

Abstract

Malignant hyperthermia (MH) is a pharmacogenetic disease of striated muscle induced by exposure to inhalational agents and succinylcholine, which can lead to serious anesthetic complications and even death. However, the mortality rate has decreased due to increased awareness for early diagnosis and prompt treatment with dantrolene. This case report described a 38-year-old Thai woman with no history of medical disease, who was admitted for total laparoscopic hysterectomy. Anesthetic induction was performed with propofol and morphine, followed by succinylcholine-facilitated trachea intubation. The patient showed neck stiffness (without masseter spasm), but tracheal intubation was successful with a video laryngoscope on the first attempt. Anesthesia was maintained with desflurane and cisatracurium. The earliest signs were hypercarbia (EtCO2 56-118 mmHg), followed by hyperthermia (max 41°C) and tachycardia. When MH was suspected, desflurane was stopped, and the patient was successfully treated with specific treatment with dantrolene, cooling as well as corrected acidosis and hyperkalemia. This case highlights the importance of early recognition, diagnosis, and prompt treatment of MH to prevent severe complications.