Abstract

ONE OF THE MORE RECENTLY recognized complications of anesthesia is malignant hyperthermia. The condition is triggered by inhalation anesthetic agents and muscle relaxants and characterized by an explosive temperature elevation which, if not treated promptly and vigorously, will almost certainly result in the patient's death. In addition to the extremely high temperature, the syndrome may include muscle rigidity, respiratory and metabolic acidosis, hyperkalemia followed by hypokalemia, elevation of creatine phosphokinase (CPK) and other serum enzymes, myoglobinuria and sometimes renal failure, hemolysis, or consumption coagulopathy. Early signs of malignant hyperthermia are failure to relax after succinylcholine administration, body stiffness at any time during operation, overheating of the soda lime canister, a rise in body temperature of more than 1 C, or cyanosis, tachypnea, or tachycardia for no obvious reason. In some instances, this is an inherited condition. The genetic pattern appears to be autosomal dominance with reduced penetrance and variable expressivity.1 Musculoskeletal disorders or myopathies have been found in some hyperthermic patients or their families or both2–4 and various investigators have found a high incidence of elevated creatine phosphokinase (CPK) in such persons.3–6This paper reports in detail the case of a man who survived a malignant hyperthermia reaction, describes his family history, and outlines a method of prevention and treatment which, if followed, might enable other patients to survive.