A Case of Atypical Postoperative Malignant Hyperthermia after the Eighth General Anesthesia in a Child with Cheilognathopalatoschisis

Abstract

Background and Objectives: Postoperative malignant hyperthermia (MH) occurs after discontinuation of volatile anesthetics or in the early postoperative period after general anesthesia. We experienced a case of atypical postoperative MH identified by dark reddish-brown urine produced 40 min after the end of eighth general anesthesia in an 11-year-old male with cheilognathopalatoschisis. Case Report: Anesthesia was induced using thiamylal, fentanyl citrate, remifentanil, rocuronium, and maintained with sevoflurane, fentanyl citrate, remifentanil. The patient was observed clenching his teeth, tachycardia, profuse perspiration, shivering-like motion, and hyperpnoea from the end of the operation to return to the HCU ward, whereas the maximum of axillary temperature was 37.9°C. Although these abnormal symptoms and vital signs were disappeared, abnormally high level of CK, AST, ALT, LDH, ALP, and myoglobinuria were recognized. We decided to not administer dantrolene hydrate because his vital signs and daily activity were restored to those observed preoperatively. However, the patient was continued infusion therapy for 9 days after the operation until the blood and urine test values returned to the preoperative ones. Conclusions: We experienced atypical postoperative MH identified by dark reddish-brown urine 40 min after the end of eighth general anesthesia. We decided not to administer dantrolene hydrate because his vital signs and daily activity were restored to those observed preoperatively when we recognized abnormally high level of CK, AST, ALT, LDH, ALP, and myoglobinuria. Consequently, rhabdomyolysis continued and in 9 days, the abnormally high values of CK, AST, ALT, LDH, and ALP recovered to the reference value.