Kouame KA*, Ango PD, Sai S, Diomandé SE, Kone K, Adingra SC and Boua N

Félix Houphouët-Boigny University, Abidjan, Côte d’Ivoire

*Corresponding Author: Kouame KA, Félix Houphouët-Boigny University, Abidjan, Côte d’Ivoire.

Received: February 01, 2023; Published: April 11, 2023

Abstract

Anesthetic malignant hyperthermia (HM) is a pharmacogenetic myopathy of anesthesia. It is induced by halogenated volatile anaesthetic agents and/or depolarizing curare (succinylcholine), in individuals with a familial muscle abnormality, transmitted in an autosomal dominant manner.

We report a probable case of fulminant HM linked to isoflurane.

The case was a 46-year-old patient with no particular medical history and had previously received uneventful general anaesthesia. Classified ASA 1 after a CPA, she was admitted to the operating room for a regulated thyroidectomy. General anaesthesia with intubation was performed with propofol and vecuronium during induction and anaesthetic maintenance with isoflurane. About 90 minutes after induction a symptomatological triad sets in: increased ETCO₂, generalized muscle rigidity and hyperthermia above 40°C. The probable hypothesis of a crisis of HM is then quickly evoked. In the absence of dantrolene as a specific treatment for HM, discontinuation of isoflurane and resuscitation measures were initiated. The consequences are marked by refractory metabolic acidosis and severe hypocalcaemia responsible for cardiac arrhythmia after several episodes of cardiac arrests resuscitated without success.

Due to a limited technical platform, confirmation of the diagnosis of anaesthetic HM in our patient could not be possible. Notamment the realization of a post-mortem muscle biopsy which would have allowed diagnostic tests of pathological contracture.

Nevertheless, the hypothesis of malignant hyperthermia of anesthesia seemed more than likely in our patient. Despite its rarity, the potentially lethal nature of this pharmacogenetic subclinical myopathy justifies that any anesthesiologist knows the elements of diagnosis and treatment of the crisis and knows how to recognize the subjects at risk to perform safe anesthesia in these patients.

 Keywords: Malignant Hyperthermia of Anesthesia; Fulminant Crisis; Isoflurane

References

1. Julien-Marsollier F., et al. “Malignant hyperthermia of anesthesia”. The Anesthesia Resuscitation Practitioner 22 (2018): 282-288.
2. Nivoche Y., et al. “What's new in malignant hyperthermia in 2012?” Annales Francaises D'anesthesie et De Reanimation 32 (2013): e43-e47.
3. Brossier T., et al. “Anesthetic malignant hyperthermia and multiple organ failure syndrome”. Annales Françaises d'Anesthésie et de Réanimation 20 (2001): 647-650.
4. Depret T and Krivosic-Horber R. “Malignant hyperthermia: diagnostic and clinical novelties”. Annales Françaises d'Anesthésie et de Réanimation 20 (2001): 838-852.
5. Payen de la Garanderie JF., et al. “Anesthetic malignant hyperthermia”. EMC-Anesthesia Resuscitation 1 (2004): 69-88.
6. Hopkins PM. “Malignant hyperthermia: advances in clinical management and diagnosis”. British Journal of Anaesthesia 85 (2000): 118-128.
7. Fu ES., et al. “Malignant hyperthermia involving the administration of desflurane”. Canadian Journal of Anaesthesia 43 (1996): 687-690.
8. Ducart A., et al. “Malignant hyperthermia during sevoflurane administration”. Anesthesia and Analgesia 80 (1995): 609-611.
9. Larach MG., et al. “A clinical grading score to predict malignant hyperthermia susceptibility”. Anesthesiology 80 (1994): 771-779.
10. Adnet P and Krivosic-Horber R. “Malignant hyperthermia and novel halogenated agents”. Annales Francaises D'anesthesie et De Reanimation 19 (2000): FI115-FI7.
11. Nelson TE., et al. “Dantrolene sodium can increase or attenuate activity of skeletal muscle ryanodine receptor calcium release channel. Clinical implication”. Anesthesiology 84 (1996): 1368-1379.
12. Expert Recommendations for the Risk of Malignant Hyperthermia, et al. Expert Recommendations for the Risk of Malignant Hyperthermia in Anesthesia Resuscitation SFAR — CRC (2013).
13. Monnier N and Lunardi J. “Biology of malignant hyperthermia: a disease of calcium channels of skeletal muscle”. Annales de Biologie Clinique 58 (2000): 147-156.
14. Ball SP and Johnson KJ. “The genetics of malignant hyperthermia”. Journal of Medical Genetics 30 (1993): 89-93.
15. Ording H. “Incidence of malignant hyperthermia in Denmark”. Anesthesia and Analgesia 64 (1985): 700-704.
16. Hopkins PM., et al. “European Malignant Hyperthermia Group guidelines for investigation of malignant hyper-thermia susceptibility”. British Journal of Anaesthesia 115 (2015): 531-539.

Citation

Citation: Kouame KA., et al. “Suspicion of a Case of Death Linked to Anesthetic Malignant Hyperthermia at Treichville University Hospital”.Acta Scientific Medical Sciences 7.5 (2023): 79-83.

Copyright

Copyright: © 2023 Kouame KA., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.