Malignant hyperthermia is a genetically transmitted, catastrophic, hypermetabolic syndrome that is induced by potent volatile anesthetics and/or depolarizing muscle relaxants. It is now well established the pathophysiology is related to a
malfunction of
the intracellular calcium homeostasis in skeletal muscle. Morbidity has been correlated to the duration of symptoms. Dantrolene decreased release of calcium from the sarcoplasmic reticulum.
We recently encountered a fulminant case during halothane anesthesia. Anesthesia was induced with thiopental and succinylcholine without jaw tightness or stiffness. After induction, tachycardia, arrhythmias, increased end-tidal CO2, and high body
temperature were noted. Arterial blood gas analysis showed a severe, mixed acidosis. Intensive treatment with body cooling was immediately initiated. But dantolene could not be available. The patient died of renal failure and disseminated
intravascular
coagulation 41 hours after induction of anesthesia.
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