Dantrolene treatment in a patient with uncontrolled hyperthemia after general anesthesia: a case report of suspected malignant hyperthermia - A case report -

Postoperative fever is relatively common after general anesthesia.Most fevers that develop within the first 48 hours after surgery are benign and self-limiting.They are most likely secondary to surgical stress or infections [1].Besides these, postoperative hyperthermia may arise from several other etiologic factors.Malignant hyperthermia (MH) is a rare and potentially life-threatening form of postoperative hyperthermia.MH is a severe hypermetabolic syndrome involving the skeletal muscles.It is usually triggered in susceptible individuals, specifically by volatile anesthetic agents and succinylcholine, although other drugs have also been implicated as potential triggers [2].In susceptible individuals, abnormal ryanodine receptors in skeletal muscle interfere with the regulation of calcium in the muscle.This causes a buildup of calcium in the skeletal muscle, resulting in an exaggerated metabolic reaction [3].This hypermetabolism overwhelms the body's capacity to supply oxygen, remove carbon dioxide, and regulate body temperature, eventually leading to circulatory collapse and death if not treated immediately.However, because of the decreased use of succinylcholine and increased use of modern volatile anesthetics (sevoflurane or desflurane), the presentation of MH is changing from fulminant to insidious [4].Nevertheless, MH can still be a lifethreatening disease and can lead to cardiac arrest.Recently, extracorporeal membrane oxygenation has been suggested as a therapeutic option in cases of MH accompanied by cardiac arrest despite immediate treatment with dantrolene [5].Dantrolene is the only therapeutic option for MH available currently.Direct or indirect inhibition of the ryanodine receptor is thought to be fundamental to the molecular action of dantrolene in decreasing the intracellular calcium concen-