Perioperative Management of a Susceptible Malignant Hyperthermia Patient in a Resource Limited Country: A Case Report

Malignant hyperthermia (MH) is an autosomal dominant genetic condition of calcium homeostasis in skeletal muscles and is primarily triggered by exposure to inhalational anaesthetics and the depolarising muscle relaxant succinylcholine. A 46-year female presented to general surgery clinic with a complaint of progressively increasing right upper quadrant abdominal pain along with shortness of breath and intermittent fever. Upon CT scan, a hepatic hydatid cyst was found. She was scheduled for laparoscopy with excision and de-roofing of the cyst under general anaesthesia. The patient was suspected to have MH based on family history. The morphological findings were also suggestive of MH on muscle biopsy. The hazards and benefits of removing a hydatid cyst urgently in light of its significant repercussions, if it ruptures, were considered. On the other hand, no availability of Dantrolene in Pakistan was also discussed. Therefore, a multidisciplinary approach, with detailed planning and preparations, was made for undertaking this high-risk surgery.