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Intra-operative hyperthermia in a cat with a fatal outcome

      Abstract

      History

      A four year old male neutered Domestic Short Hair cat presented for general anaesthesia for hind limb orthopaedic surgery. The cat had been anaesthetized four days previously with propofol and isoflurane and made an uneventful recovery.

      Physical Examination and Management

      On pre-anaesthetic examination the cat had a temperature of 38.9 °C and was otherwise healthy. After a premedication of acepromazine and pethidine, anaesthesia was induced with thiopental and maintained with isoflurane in oxygen 50% and nitrous oxide 50%. Increases in heart rate, respiratory rate, end tidal carbon dioxide tension and temperature were observed, occurring sequentially, from 110 to 175 minutes after anaesthetic induction. Despite ceasing all warming measures and attempting to cool the patient, body temperature continued to rapidly rise, reaching 42.5 °C and limb rigidity was observed. Isoflurane administration was stopped and esmolol was administered. Cardiac arrest occurred. Cardio-pulmonary cerebral resuscitation was commenced and a lateral thoracotomy was performed to allow cardiac compressions and internal defibrillation. Atropine, adrenaline, glucose and dopamine were administered and cold saline was instilled into the thoracic cavity.

      Follow-up

      Resuscitation was unsuccessful and the cat died.

      Conclusions

      A presumptive diagnosis of malignant hyperthermia was made. Malignant hyperthermia should be considered, even if prior exposure to volatile inhalational anaesthesia was uneventful, and prompt and aggressive therapy instituted.

      Keywords

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      References

        • Adami C
        • Axiak S
        • Raith K
        • et al.
        Unusual perianesthetic malignant hyperthermia in a dog.
        J Am Vet Med Assoc. 2012; 240: 450-453
        • Adler MW
        • Geller EB
        • Rosow CE
        • et al.
        The opioid system and temperature regulation.
        Annu Rev Pharmacol Toxicol. 1988; 28: 429-449
        • Aleman M
        • Brosnan RJ
        • Williams DC
        • et al.
        Malignant hyperthermia in a horse anesthetized with halothane.
        J Vet Int Med. 2005; 19: 363-366
        • Aleman M
        • Nieto JE
        • Magdesian KG
        Malignant hyperthermia associated with ryanodine receptor 1 (C7360G) mutation in Quarter Horses.
        J Vet Int Med. 2009; 23: 329-334
        • Bellah JR
        • Robertson SA
        • Buergelt CD
        • et al.
        Suspected malignant hyperthermia after halothane anesthesia in a cat.
        Vet Surg. 1989; 18: 483-488
        • Brunson DB
        • Hogan KJ
        Malignant hyperthermia: a syndrome not a disease.
        Vet Clin North Am Small Anim Pract. 2004; 34: 1419-1433
        • Campbell IT
        • Ellis FR
        • Evans RT
        • et al.
        Studies of body temperatures, blood lactate, cortisol and free fatty acid levels during exercise in human subjects susceptible to malignant hyperpyrexia.
        Acta Anaesthesiol Scand. 1983; 27: 349-355
        • Capacchione JF
        • Muldoon SM
        The relationship between exertional heat illness, exertional rhabdomyolysis, and malignant hyperthermia.
        Anesth Analg. 2009; 109: 1065-1069
        • Fujii J
        • Otsu K
        • Zorzato F
        • et al.
        Identification of a mutation in porcine ryanodine receptor associated with malignant hyperthermia.
        Science. 1991; 253: 448-451
        • Gellasch KL
        • Kruse-Elliott KT
        • Osmond CS
        • et al.
        Comparison of transdermal adminstration of fentanyl versus intramuscular administration of butorphanol for analgesia after onychectomy in cats.
        J Am Vet Med Assoc. 2002; 220: 1020-1024
        • Glahn KP
        • Ellis FR
        • Halsall PJ
        • et al.
        Recognizing and managing a malignant hyperthermia crisis: guidelines from the European Malignant Hyperthermia Group.
        Br J Anaesth. 2010; 105: 417-420
        • Gronert GA
        Malignant hyperthermia.
        Anesthesiology. 1980; 53: 395-423
        • Gronert GA
        • Theye RA
        • Milde JH
        • et al.
        Catecholamine stimulation of myocardial oxygen consumption in porcine malignant hyperthermia.
        Anesthesiology. 1978; 49: 330-337
        • Hall LW
        • Woolf N
        • Bradley JW
        • et al.
        Unusual reaction to suxamethonium chloride.
        Br Med J. 1966; 26: 1305
        • Halsall PJ
        • Hopkins PM
        Malignant Hyperthermia.
        Contin Educ Anaesth Crit Care Pain. 2003; 3: 5-9
        • Hopkins PM
        Malignant hyperthermia: advances in clinical management and diagnosis.
        Br J Anaesth. 2000; 85: 118-128
        • Ilkiw JE
        • Pascoe PJ
        • Fisher LD
        Effect of alfentanil on the minimum alveolar concentration of isoflurane in cats.
        Am J Vet Res. 1997; 58: 1274-1279
        • de Jong RH
        • Heavner JE
        • Amory DW
        Malignant hyperpyrexia in the cat.
        Anesthesiology. 1974; 41: 608-609
        • Kirmayer AH
        • Klide AM
        • Purvance JE
        Malignant hyperthermia in a dog: case report and review of the syndrome.
        J Am Vet Med Assoc. 1984; 185: 978-982
        • Klein L
        • Ailes N
        • Fackelman GE
        • et al.
        Postanesthetic equine myopathy suggestive of malignant hyperthermia. A case report.
        Vet Surg. 1989; 18: 479-482
        • Manley SV
        • Kelly AB
        • Hodgson D
        Malignant hyperthermia-like reactions in three anesthetized horses.
        J Am Vet Med Assoc. 1983; 183: 85-89
        • Nelson TE
        Malignant hyperthermia in dogs.
        J Am Vet Med Assoc. 1991; 198: 989-994
        • Niedfeldt RL
        • Robertson SA
        Postanesthetic hyperthermia in cats: a retrospective comparison between hydromorphone and buprenorphine.
        Vet Anaesth Analg. 2006; 33: 381-389
        • Niemann JT
        • Cairns CB
        Hyperkalemia and ionized hypocalcemia during cardiac arrest and resuscitation: possible culprits for postcountershock arrhythmias?.
        Ann Emerg Med. 1999; 34: 1-7
        • Ording H
        Incidence of malignant hyperthermia in Denmark.
        Anesth Analg. 1985; 64: 700-704
        • Posner LP
        • Pavuk AA
        • Rokshar JL
        • et al.
        Effects of opioids and anesthetic drugs on body temperature in cats.
        Vet Anaesth Analg. 2010; 37: 35-43
        • Roberts MC
        • Mickelson JR
        • Patterson EE
        • et al.
        Autosomal dominant canine malignant hyperthermia is caused by a mutation in the gene encoding the skeletal muscle calcium release channel (RYR1).
        Anesthesiology. 2001; 95: 716-725
        • Rosero EB
        • Adesanya AO
        • Timaran CH
        • et al.
        Trends and outcomes of malignant hyperthermia in the United States, 2000 to 2005.
        Anesthesiology. 2009; 110: 89-94
        • Strazis KP
        • Fox AW
        Malignant hyperthermia: a review of published cases.
        Anesth Analg. 1993; 77: 297-304
        • Sumitani M
        • Uchida K
        • Yasunaga H
        • et al.
        Prevalence of malignant hyperthermia and relationship with anesthetics in Japan: data from the diagnosis procedure combination database.
        Anesthesiology. 2011; 114: 84-90
        • Urwyler A
        • Deufel T
        • McCarthy T
        • et al.
        Guidelines for molecular genetic detection of susceptibility to malignant hyperthermia.
        Br J Anaesth. 2001; 86: 283-287
        • Wedel DJ
        • Gammel SA
        • Milde JH
        • et al.
        Delayed onset of malignant hyperthermia induced by isoflurane and desflurane compared with halothane in susceptible swine.
        Anesthesiology. 1993; 78: 1138-1144