This case report highlights a fatal instance of malignant hyperthermia triggered by isoflurane during scoliosis surgery in a pediatric patient.
Fatal delayed-onset malignant hyperthermia may occur with isoflurane in pediatric scoliosis surgery; single case leaves open incidence and prevention questions.
Malignant hyperthermia is a potentially fatal hypermetabolic syndrome characterized by skeletal muscle rigidity and hyperpyrexia. We had an 11-year-old female presented for a surgery for idiopathic scoliosis of the thoracic vertebra. Generalized muscle rigidity and tachycardia were revealed 1 hour 35 minutes after isoflurane administration. Then the body temperature was risen to 43degrees C within 10 minutes and the arterial blood gas analysis showed a severe respiratory and metabolic acidosis. Under the suspicion of malignant hyperthermia, the patient was treated by discontinuing all anesthetic agents, hyperventilation with 100% oxygen, surface cooling with ice pack and the administration of dantrolene sodium. But, the patient died of renal failure and disseminated intravascular coagulation after 50 days postoperatively.
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Kim et al. (2009) studied this question.
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