Korean J Anesthesiol.  2002 Nov;43(5):667-672. 10.4097/kjae.2002.43.5.667.

Early Recognition of Malignant Hyperthermia with Capnography: A case report

• Kim DC
• Lim HR
• Han YJ

• KMID: 2091741
• DOI: http://doi.org/10.4097/kjae.2002.43.5.667

Abstract

Malignant hyperthemia is an autosomal-dominant inherited disorder of the skeletal muscle cell charac terized by a hypermetabolic response to all commonly used inhalational anesthetics and depolarizing muscle relaxants. The clinical syndrome includes muscle rigidity, hypercapnia, tachycardia and myoglobinuria as result of increased carbon dioxide production, oxygen consumption and muscle membrane breakdown. Early recognition and vigorous treatment are very important factors to determine patient's prognosis in malignant hyperthermia. However, it is very difficult to diagnose malignant hyperthermia during anesthesia because malignant hyperthermia presents with multiple nonspecific signs and laboratory findings of variable intensity and time course during and after exposure to anesthetic agents. We report a case of malignant hyperthermia which was diagnosed early using capnography before the appearance of hyperthermia and successfully treated. The malignant hyperthermia episode developed 20 minutes after induction of anesthesia with thiopental sodium, pancuronium, isoflurane, N2O and O2. When we suspected episode, we could not observe any classical signs of malignant hyperthermia except unexplained tachycardia and elevated end-tidal CO2. We discuss here the usefulness of capnography in early recognition of malignant hyperthermia and the importance of early recognition in prognosis.

Keyword

Capnography; end-tidal CO2; malignant hyperthermia

MeSH Terms

Anesthesia
Anesthetics
Capnography*
Carbon Dioxide
Fever
Hypercapnia
Isoflurane
Malignant Hyperthermia*
Membranes
Muscle Rigidity
Muscle, Skeletal
Myoglobinuria
Neuromuscular Depolarizing Agents
Oxygen Consumption
Pancuronium
Prognosis
Tachycardia
Thiopental
Anesthetics
Carbon Dioxide
Isoflurane
Neuromuscular Depolarizing Agents
Pancuronium
Thiopental