A case of malignant hyperthermia?

Safety features in anaesthesia machine

Anaesthesia is one of the few sub-specialties of medicine, which has quickly adapted technology to improve patient safety. This application of technology can be seen in patient monitoring, advances in anaesthesia machines, intubating devices, ultrasound for visualisation of nerves and vessels, etc., Anaesthesia machines have come a long way in the last 100 years, the improvements being driven both by patient safety as well as functionality and economy of use. Incorporation of safety features in anaesthesia machines and ensuring that a proper check of the machine is done before use on a patient ensures patient safety. This review will trace all the present safety features in the machine and their evolution.

Malignant Hyperthermia or Not Malignant Hyperthermia

In an acute event, the diagnosis of malignant hyperthermia (MH) in patients in the ICU can be challenging. Initial presentation may be attributed to a gamut of causes, making the diagnosis complicated. This example is the case of a 46-year-old African American man who was admitted to the Stroke Service and intubated for respiratory distress. To facilitate intubation, he was given etomidate and succinylcholine. Within an hour, a sustained increase in arterial carbon dioxide concentration, rhabdomyolysis, and later on, hyperthermia, developed. He was started on broad-spectrum antibiotics, aggressive fluid hydration, and mechanical ventilation. He had had one previous uneventful anesthesia exposure and he denied having any family member having anesthesia complications. With a very convoluted presentation, a high degree of suspicion for MH warranted appropriate treatment to avoid significant morbidity and/or mortality. Moreover, until the diagnosis is confirmed, education regarding the disease process to patients and their family members is as vital as the treatment itself. The main objective of this case is to present a diagnostic dilemma in a probable MH patient who is in a state of shock in the ICU.