Anaesthesia considerations for concurrent renal transplant surgery in a pair of malignant hyperthermia susceptible patients: A comprehensive perioperative approach
Malignant hyperthermia (MH) is a rare, life-threatening hypermetabolic reaction to volatile anaesthetics and succinylcholine. Management of MH-susceptible patients undergoing elective surgery has been reported; however, concurrent transplant surgeries involving two MH-susceptible patients pose uniqu...
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| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
SAGE Publishing
2025-06-01
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| Series: | Proceedings of Singapore Healthcare |
| Online Access: | https://doi.org/10.1177/20101058251355352 |
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| Summary: | Malignant hyperthermia (MH) is a rare, life-threatening hypermetabolic reaction to volatile anaesthetics and succinylcholine. Management of MH-susceptible patients undergoing elective surgery has been reported; however, concurrent transplant surgeries involving two MH-susceptible patients pose unique challenges. This report describes the perioperative management for a living-related renal transplant involving a donorrecipient pair both at risk for MH, highlighting the perioperative considerations and logistical challenges of preparing for potential simultaneous MH crises in high-stakes surgical scenarios. A 49-year-old woman with end-stage renal disease and her 29-year-old daughter were scheduled for living-related kidney transplantation. Both patients had a family history of MH but declined confirmatory testing. Preoperative planning centered around multidisciplinary discussions, crisis simulation, and preparation of two sets of trigger-free anaesthesia workstations, MH kits, cooling supplies, and resuscitation equipment. A trigger-free anaesthesia technique was employed. Two anaesthetic teams coordinated between the donor nephrectomy and recipient transplant at critical time points during the surgery. The surgeries proceeded smoothly, and both patients were stable intraoperatively with an uneventful recovery in High Dependency. This case highlights the importance of comprehensive perioperative preparations, including contingency planning, team coordination, and resource allocation, to manage potential simultaneous MH crises in concurrent surgeries. Future efforts to develop standardized protocols for scenarios involving concurrent surgeries in MH-susceptible patients and improving access to MH confirmatory testing would improve outcomes and streamline perioperative care in similar cases. |
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| ISSN: | 2059-2329 |