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Suspected malignant hyperthermia: case report A 49-year-old man developed suspected malignant hyperthermia following local infiltration anaesthesia with lidocaine/epinephrine [adrenaline]. The man, who was scheduled for a right inguinal hernia repair, received cefazolin and pentazocine. He then underwent infiltration anaesthesia with 0.5% lidocaine/ epinephrine 15mL [route not stated]. Two minutes later, he experienced systemic clonic convulsions. Diazepam was administered, but his convulsions persisted. He had a body temperature of 37.8°C. Diazepam was administered again, and epinephrine was given with steroids and antihistamines for suspected cefazolin anaphylaxis. His body temperature increased to 38.4°C, and his pulse rate increased from 109 beats/min to 147 beats/min. His body temperature and pulse rate increased again to 39.0°C and 155 beats/min, respectively, and malignant hyperthermia was suspected. The patient underwent general cooling and received dantrolene. Afterwards, his convulsions disappeared. His pulse rate and body temperature decreased to 97 beats/min and 37.1°C, respectively. He was transferred to another hospital where he underwent right inguinal hernia repair with total intravenous anaesthesia uneventfully. A muscle biopsy was done, and he was diagnosed with abnormal ryanodine receptor 1 (RyR1) function. Author comment: Malignant hyperthermia is listed as an adverse drug reaction of lidocaine on the package insert. Kamitani K, et al. A case suspected of malignant hyperthermia after local infiltration anesthesia. Masui. The Japanese Journal of Anesthesiology 61: 866-868, No. 8, Aug 2012 [Japanese; summarised from a translation] 803079123 Japan

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Reactions 3 Nov 2012 No. 1426