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Anesthesia and analgesia · Feb 2004
Case ReportsA suspected case of delayed onset malignant hyperthermia with desflurane anesthesia.
- Thomas J Papadimos, Mohamad Almasri, James C Padgett, and Joanne E Rush.
- Department of Anesthesiology, Medical College of Ohio, St. Luke's Hospital Heart Center, Maumee, USA. Tpapadimos@mac.com
- Anesth. Analg. 2004 Feb 1;98(2):548-9, table of contents.
UnlabelledDesflurane has been identified as a weak triggering anesthetic of malignant hyperthermia that, in the absence of succinylcholine, may produce a delayed onset of symptoms. The prolonged interval after exposure may occur more than 6 h after the induction of anesthesia. The unintended underdosing of this patient with dantrolene and the prompt reversal of symptoms may be an attribute of the genetic expression of a weak triggering volatile anesthetic such as desflurane.ImplicationsThere are multiple genetic variations for malignant hyperthermia (MH) at the ryanodine receptor. Desflurane, as a sole trigger of MH, is weak, and on two occasions in the literature (including this case), less than optimal doses of dantrolene were given with a good result. There may be possible to engineer the risk of MH out of an anesthetic once the genetics of the ryanodine receptor are better understood.
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