Malignant hyperthermia: a case report of successful management.

THE MORTALITY associated with malignant hyperthermia was 77 per cent in 1967 ~ but had decreased to 64 per cent in 19703 primarily because of increased awareness by anaesthetists of the early signs of this syndrome and the prompt initiation of prompt therapy. The incidence of malignant hyperthermia in children is 1;10,000, with a range of 1:5,000 to 1:70,0007 However, our experience at the Vancouver General Hospital indicates the incidence in adults differs markedly from that in children. During the past ten years ( 1961 to 1970 inclusive) approximately 290,000 general anaesthetics were administered at our institution to adult patients with the development of malignant hyperthermia in only one case. 4 Patient ages have ranged from six months ~ to 70 years, ~ but the maiority of patients were less than 30 years of age. At present we are aware of 176 patients who have developed this syndrome characterized by severe pyrexi~ of sudden or insidious onset, often associated with skeletal muscle rigidity, during or following the administration of a muscle relaxant and/or potent inhalation anaesthetic agent. The various aspects of this syndrome, i.e. aetiology, 3,8,1~ pathophysiology, l~ clinical manifestations, 1,2,8,13 laboratory findings 2 and management ~,7,s,13~14 have been fully described in the literature. Our reasons for presenlSng this paper are threefold: first, to describe our recent experience of an unpublished ease of apparently succinyldicholine-indueed malignant hyperthermia in a healthy child; secondly, to illustrate an unusually rapid and fulminant rise of body temperature; and finally, to re-emphasize the important features of successful management of this syndrome. Such therapy includes continuous monitoring of body temperature, early recognition of signs characteristic of this syndrome, prompt cessation of anaesthesia and operation, immediate judicious treatment and continuous follow-up for 48 to 72 hours. The following ease report describes these principles, the application of which has led to the complete recovery of the patient from this serious anaesthetic complication.