Malignant Hyperthermia: A case report in a trauma patient

Publication date: Available online 19 July 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Ian C. Gibbs, Oluwole Fadahunsi, Natoya Reid, Andrea M. Bonnick

Abstract

Malignant hyperthermia is a rare condition that occurs in susceptible patients exposed to triggering anesthetic agents. It is associated with a high mortality if not recognized immediately and treated appropriately.

A 52 year old male presented to our clinic two days status post assault for management of jaw pain. A minimally displaced right parasymphyseal fracture and moderately displaced left body fracture of mandible were diagnosed.

There were no known drug allergies. He reported no previous difficulty with anesthesia as well as no known prior adverse reactions to anesthesia in any relatives.

Planned surgical intervention was open reduction internal fixation of bilateral mandible fractures. The patient received succinylcholine and desflurane during the procedure. A full 70 minutes elapsed before initial signs of hypermetabolism were noted, namely a rise in EtCO₂. The patient received dantrolene sodium approximately 120 minutes after induction of anesthesia. Signs of hypermetabolism began to abate within 45 minutes of commencing malignant hyperthermia treatment protocol. He was subsequently transferred to the surgical intensive care unit for continued management and had a favorable postoperative course.

This case underscores the importance of awareness of malignant hyperthermia and its presentation. This condition carries a potential high risk for complications following exposure to triggering anesthetic agents. Taking a complete and detailed history may help to identify potential cases. In this case, it was subsequently discovered that patient's biological sister had a near fatal reaction with general anesthesia several years prior to this incident. Intra-operative vigilance to the monitoring of vital signs cannot be overemphasized. An increase in end tidal carbon dioxide values, in addition to other clinical signs that cannot be easily attributed to other causes, should increase the clinical index of suspicion for a diagnosis.

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