A suspected case of delayed onset malignant hyperthermia with desflurane anesthesia.
Desflurane 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.


CONCLUSIONS
There 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.
Papadimos
Thomas J
TJ
Department of Anesthesiology, Medical College of Ohio, St. Luke's Hospital Heart Center, Maumee.
Almasri
Mohamad
M
Padgett
James C
JC
Rush
Joanne E
JE
D000769:Anesthesia, Inhalation / Q000009:adverse effects*; D018685:Anesthetics, Inhalation / Q000009:adverse effects*; D000077335:Desflurane; D006801:Humans; D007530:Isoflurane / Q000009:adverse effects* / Q000031:analogs & derivatives*; D008297:Male; D008305:Malignant Hyperthermia / Q000503:physiopathology*; D008875:Middle Aged; D009369:Neoplasms / Q000601:surgery; D013908:Thoracotomy
D018685:Anesthetics, Inhalation; D000077335:Desflurane; D007530:Isoflurane