Published December 1, 2008
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Postoperative Malignant Hyperthermia An Analysis of Cases from the North American Malignant Hyperthermia Registry
Description
Background: The initial presentation of malignant hyperthermia
(MH) may begin in the postoperative period. However,
the maximal latency period between the end of anesthesia care
and the onset of postoperative MH is unknown. The authors
hypothesized that this latency period is short and is not manifested
by hyperthermia as the initial presenting sign. The authors
sought to test this hypothesis and to describe the clinical
characteristics of postoperative MH by analysis of suspected
cases in the North American Malignant Hyperthermia Registry.
Methods: Of 528 possible or suspected cases of MH in the
North American Malignant Hyperthermia Registry, the authors
identified 64 possible reports of postoperative MH. The records
were reviewed in detail by the authors, each of whom assigned
a qualitative score of "likely," "not likely," "not enough information
available," or "not applicable" (where MH was not the
final definitive diagnosis). Postoperative MH was confirmed
after a consensus meeting of the three senior authors who
reviewed in detail all possible "likely" cases.
Results: The authors identified postoperative MH in 10 subjects.
All received volatile agents and 5 also received succinylcholine.
All demonstrated signs characteristic of acute MH, including
generalized rigidity, hypercapnia and/or tachypnea,
tachycardia, and hyperthermia. No subject demonstrated hyperthermia
as the presenting sign. The latency period between
the anesthesia finish time and the onset of a sign indicative of
acute MH ranged from 0 to 40 min.
Conclusions: Postoperative MH is uncommon, occurring in
10 of 528 suspected MH cases (1.9%) reported to the North
American Malignant Hyperthermia Registry. Postoperative MH
began shortly after completion of the anesthetic care. Hyperthermia
was not a presenting sign of MH.
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