title: Delayed onset of suspected malignant hyperthermia during sevoflurane anesthesia in an Afghan trauma patient: a case report.
abstract: Malignant hyperthermia (MH) is a rare pathologic hypermetabolic pharmacogenetic disorder of skeletal muscle calcium regulation following exposure to depolarizing muscle relaxants and/or volatile anesthetics. Although its pathogenesis is relatively well understood, there is wide variability in both the time of onset and the presentation of clinical signs and symptoms. In some circumstances the delayed onset of the hypermetabolic state may hinder timely recognition and treatment. Differential diagnosis of an MH crisis can be particularly challenging in a trauma patient, especially in an austere environment. This case report describes the presentation and management of a suspected case of MH in an Afghan national who underwent surgery following lower extremity trauma resulting from an improvised explosive device.
authors.affiliation: Naval Medical Center San Diego, CA, USA. rafal.banek@med.navy.mil
authors.forename: Rafal
authors.initials: R
authors.lastname: Banek
authors.affiliation: Naval Hospital Jacksonville, Florida, USA.
authors.forename: John
authors.initials: J
authors.lastname: Weatherwax
authors.affiliation: NAVMEDWEST Region, Naval Medical San Diego, CA, USA.
authors.forename: Dennis
authors.initials: D
authors.lastname: Spence
authors.affiliation: Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Perry
authors.affiliation: Malignant Hyperthermia Testing Center, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
authors.forename: Sheila
authors.initials: S
authors.lastname: Muldoon
authors.affiliation: School of Medicine, Department of Anesthesiology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
authors.forename: John
authors.initials: J
authors.lastname: Capacchione
mesh_terms: D055826:Afghan Campaign 2001-; D018685:Anesthetics, Inhalation / Q000009:adverse effects*; D004632:Emergency Medical Services; D006801:Humans; D008297:Male; D008305:Malignant Hyperthermia / Q000209:etiology*; D008738:Methyl Ethers / Q000009:adverse effects*; D000077149:Sevoflurane; D013997:Time Factors; D014947:Wounds and Injuries / Q000601:surgery*; D055815:Young Adult
chemical_list: D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D000077149:Sevoflurane