Key result
Remimazolam-alfentanil sedation combined with caudal block was successfully used in a 1-year-old child with genetically confirmed malignant hyperthermia susceptibility without triggering any MH manifestations.
Why the study?
Patients with malignant hyperthermia susceptibility must avoid volatile anesthetics and succinylcholine, but evidence supporting remimazolam use in pediatric patients remains scarce.
Does remimazolam and alfentanil sedation combined with caudal block provide safe anesthesia without triggering malignant hyperthermia in a pediatric patient with RYR1 mutations?
Case Report (n=1)
No
Does remimazolam and alfentanil sedation combined with caudal block provide safe anesthesia without triggering malignant hyperthermia in a pediatric patient with RYR1 mutations?
Remimazolam-alfentanil sedation combined with caudal block appears to be a safe and feasible anesthetic strategy for pediatric patients with malignant hyperthermia susceptibility.
May support remimazolam-alfentanil use in MH-susceptible pediatric cases; hypothesis-generating and leaves open need for larger confirmatory studies.
BACKGROUND: Malignant hyperthermia (MH) is a life-threatening autosomal-dominant disorder caused by mutations in the ryanodine receptor 1 (RYR1) gene, leading to calcium dysregulation in skeletal muscle. Patients with genetically confirmed MH susceptibility must strictly avoid volatile anesthetics and succinylcholine. Intravenous sedation presents a viable alternative, yet evidence supporting remimazolam use in pediatric MH patients remains scarce. CASE PRESENTATION: We report the first case of a 1-year-old male patient with genetically confirmed MH susceptibility undergoing orchidopexy under remimazolam-alfentanil sedation combined with caudal block. The patient had no MH manifestations intraoperatively or postoperatively and recovered uneventfully. CONCLUSION: This case demonstrates the feasibility of remimazolam-based sedation in genetically confirmed pediatric MH patients, supporting its safety profile in this population. Further multicenter studies are needed to establish standardized protocols.
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Zhu et al. (2025) conducted a case report in Malignant hyperthermia susceptibility (n=1). Remimazolam and alfentanil sedation was evaluated on Occurrence of malignant hyperthermia manifestations. Remimazolam-alfentanil sedation combined with caudal block was successfully used in a 1-year-old child with genetically confirmed malignant hyperthermia susceptibility without triggering any MH manifestations.
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