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Canadian Journal of Anesthesia, Vol 36, 81-85, Copyright © 1989 by Canadian Anesthesiologists' Society

ARTICLES

Rewarming following hypothermic cardiopulmonary bypass in the malignant hyperthermia-susceptible patient: implications for diagnosis and perioperative management

GC Allen and CB Cattran
Department of Anaesthesia, University of Ottawa, Ontario.

A 55-year-old, malignant hyperthermia-susceptible patient underwent myocardial revascularization without incident. Six hours postoperatively, he developed what was initially diagnosed as an MH crisis, for which he received intravenous dantrolene. The resultant muscle weakness prolonged the duration of postoperative mechanical ventilation and likely contributed to the development of a postoperative pneumonia. Plasma dantrolene levels were measured for the first 48 hours postoperatively and correlated with clinical findings. On reviewing the patient's perioperative course, it was felt that the hypermetabolic state was not due to MH. The patient's pattern of rewarming following hypothermic cardiopulmonary bypass was similar to non-MH-susceptible patients. Because of the difficulty in diagnosing a MH crisis after hypothermic bypass, it is recommended that patients receive prophylactic dantrolene preoperatively and after bypass. Nondepolarizing muscle relaxants should be given postoperatively to prevent shivering and respiratory acidosis while patients rewarm.


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A. D. Lichtman and C. Oribabor
Can We Prevent Malignant Hyperthermia After Hypothermic Cardiopulmonary Bypass in a Malignant Hyperthermia-Susceptible Patient?
Anesth. Analg., January 1, 2007; 104(1): 214 - 215.
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Copyright © 1989 by the Canadian Anesthesiologists' Society.