Challenges in the management of malignant hyperthermia in Colombia: Case report

Malignant hyperthermia is a potentially life-threatening pharmacogenetic disorder characterized by a hypermetabolic response triggered by exposure to halogenated anesthetics, succinylcholine, and other agents. This is a case of a 40-year-old woman who developed masseter muscle spasm, bronchospasm, hypercapnia, muscle stiffness, and hyperthermia upon the administration of general anesthesia at a clinic in the capital of Colombia. This resulted in a high clinical suspicion of malignant hyperthermia and hence the institutional protocol for management of this condition was activated. It should be highlighted however that the drug used to treat this condition—dantrolene—is not readily available at most clinical institutions in Colombia and in this case a special emergency line must be used in order for the drug to be delivered. Once the drug was received and administered, the patient experienced clinical and hemodynamic recovery, with satisfactory postoperative response. She was discharged on day five without any sequelae. This case report reviews the pathophysiology, diagnosis, and treatment for malignant hyperthermia, as well as the challenges in accessing pharmacological treatment in Colombia.