Can We Prevent Malignant Hyperthermia After Hypothermic Cardiopulmonary Bypass in a Malignant Hyperthermia-Susceptible Patient?

Abstract

In Response: We are gratified that our report (1) may have shed some new light on an unusual presentation of malignant hyperthermia (MH) in the case reported by Siddik-Sayyid et al. (2) However, the literature does not support the routine use of perioperative dantrolene in MH-susceptible patients. Hackl et al., 3 in their review of 30 anesthetics given to 24 in vitro, contracture, test-positive patients noted that none developed MH when given a nontriggering anesthetic. In fact, Allen and Cattran (4) reported that the postoperative pneumonia that developed in their MH-susceptible patient after dantrolene treatment was likely due to muscle weakness from the dantrolene itself. On the basis of these reports and others, we elected not to pretreat our patient with dantrolene. Also, given that MH may present in different ways and multiple anesthetics may be required before MH manifests itself, one cannot say for certain that any one technique or therapeutic addition prevented the development of MH in Siddik-Sayyid et al.’s patient. However, the fact that this patient did not develop MH from this anesthetic encounter we are sure was a great relief to the authors, and for that we offer well-deserved congratulations and job well done! Adam D. Lichtman, MD Department of Anesthesiology Weill-Cornell Medical Center, New York [email protected] Charles Oribabor, MD Cardiothoracic Intensive Care Unit New York Methodist Hospital Brooklyn, New York