Malignant hyperthermia in postpartum hemorrhagic shock: A case report

Abstract

© JOURNAL OF THE MEDICAL ASSOCIATION OF Thailand | 2019 Malignant hyperthermia is a rare and lethal pharmacogenetic disorder. The susceptible individuals develop hypermetabolic responses when exposed to volatile anesthetic agents and Succinylcholine. The authors reported a Malignant hyperthermia case in postpartum hemorrhagic shock patient scheduled for emergency hysterectomy, eight hours after cesarean section for dichorionic diamniotic twins under spinal block. General anesthesia with endotracheal intubation with rapid sequence induction was performed. After having received Succinylcholine and Desflurane, the patient developed masseter spasm, hypercarbia, hyperthermia, rhabdomyolysis, cardiac arrhythmia, hypotension, and combined metabolic-respiratory acidosis. The clinical symptoms and signs of malignant hyperthermia in this patient were detected early. Symptomatic treatments and dantrolene were administered. The clinical signs improved, and the patient was discharged from intensive care unit on post-operative day 3. The molecular genetic testing was performed and the mutation in RYR1 gene was found in this patient, compatible with Malignant Hyperthermia. Being vigilant and early detection are the key elements for successful Malignant hyperthermia management.