Malignant hyperthermia during laparoscopic adjustable gastric banding

Abstract

Background: We report a rare case of malignant hyperthermia during laparoscopic adjustable gastric banding.

Case description: A 32-y-old female with no previous history of adverse reaction to general anesthesia underwent laparoscopic adjustable gastric banding. Intraoperative monitoring revealed a sharp increase in end-tidal carbon dioxide, autonomic instability, and metabolic and respiratory acidosis, along with other metabolic and biochemical derangements. She was diagnosed with malignant hyperthermia. Desflurane, the anesthetic agent was discontinued, and the patient was started on intravenous dantrolene.

Results: The surgery was completed, and the patient was brought to the surgical intensive care unit for continued postoperative care. She developed muscle weakness and phlebitis that resolved prior to discharge.

Conclusion: Prompt diagnosis and treatment of malignant hyperthermia leads to favorable clinical outcome. This clinical entity can occur in the bariatric population with the widely used desflurane. Bariatric surgeons and anesthesiologists alike must be aware of the early clinical signs of this rare, yet potentially fatal, complication.

Figure 1.

Intraoperative anesthetic course. Anesthesia induction occurred at 20 min. At 80 min (60 min after induction) MH was diagnosed, desflurane was discontinued and dantrolene was started. The patient responded immediately to treatment, and reversal of metabolic derangements was observed.