Malignant Hyperthermia in Postpartum Hemorrhagic
Shock: A
Case Report:
Sumphaongern T, MD¹, Nilyam P, MD²
Affiliation : ¹ Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand ² Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand
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.
Keywords : Malignant hyperthermia, Hyperthermia, Dantrolene, Hypercarbia
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