Rewarming following hypothermic cardiopulmonary bypass in the malignant hyperthermia-susceptible patient: implications for diagnosis and perioperative management

A 55-year-old, malignant hyperthermia-susceptible patient underwent myocardial revascularization without incident. Six hours postoperatively, he developed what was initially diagnosed as an MH crisis, for which he received intravenous dantrolene. The resultant muscle weakness prolonged the duration...

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Bibliographic Details
Published inCanadian journal of anesthesia Vol. 36; no. 1; pp. 81 - 85
Main Authors ALLEN, G. C, CATTRAN, C. B
Format Journal Article
LanguageEnglish
Published Toronto, ON Canadian Anesthesiologists' Society 1989
Subjects
Anesthesia
Anesthesia depending on type of surgery
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Biological and medical sciences
Cardiopulmonary Bypass
Dantrolene - therapeutic use
Disease Susceptibility
Hot Temperature - therapeutic use
Humans
Hypothermia, Induced
Male
Malignant Hyperthermia - prevention & control
Malignant Hyperthermia - surgery
Medical sciences
Middle Aged
Thoracic and cardiovascular surgery. Cardiopulmonary bypass
Cardiopulmonary bypass
Human
Malignant hyperthermia
Risk factor
General anesthesia
Induced hypothermia
Patient warming
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Summary:A 55-year-old, malignant hyperthermia-susceptible patient underwent myocardial revascularization without incident. Six hours postoperatively, he developed what was initially diagnosed as an MH crisis, for which he received intravenous dantrolene. The resultant muscle weakness prolonged the duration of postoperative mechanical ventilation and likely contributed to the development of a postoperative pneumonia. Plasma dantrolene levels were measured for the first 48 hours postoperatively and correlated with clinical findings. On reviewing the patient's perioperative course, it was felt that the hypermetabolic state was not due to MH. The patient's pattern of rewarming following hypothermic cardiopulmonary bypass was similar to non-MH-susceptible patients. Because of the difficulty in diagnosing a MH crisis after hypothermic bypass, it is recommended that patients receive prophylactic dantrolene preoperatively and after bypass. Nondepolarizing muscle relaxants should be given postoperatively to prevent shivering and respiratory acidosis while patients rewarm.
Bibliography:ObjectType-Case Study-2
SourceType-Scholarly Journals-1
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ISSN:0832-610X
1496-8975
DOI:10.1007/BF03010893