Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Anesthesiol. Jul 28, 2023; 12(1): 1-7
Published online Jul 28, 2023. doi: 10.5313/wja.v12.i1.1
Malignant hyperthermia as a rare complication of local lidocaine injection: A case report
Mukosolu Florence Obi, Manveer Ubhi, Vikhyath Namireddy, Chelsea Noel, Manjari Sharma, Frederick N Campos, Yash Garg
Mukosolu Florence Obi, Manveer Ubhi, Manjari Sharma, Frederick N Campos, Yash Garg, Department of Internal Medicine, Wyckoff Heights Medical Center, New York, NY 11237, United States
Vikhyath Namireddy, Chelsea Noel, Department of Medicine, St. Georges University School of Medicine, True Blue 38902, Grenada
Author contributions: Obi MF contributed to manuscript writing and editing, and data analysis; Namireddy V and Noel C contributed to data collection; Ubhi M, Garg Y, Sharma M, and Campos FN contributed to conceptualization and supervision; all authors read and approved the final manuscript.
Informed consent statement: Informed verbal consent was obtained from the patient for publication of this case report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mukosolu Florence Obi, MD, Doctor, Department of Internal Medicine, Wyckoff Heights Medical Center, 374 Stockholm St, Brooklyn, New York, NY 11237, United States. omukosolu.florence@gmail.com
Received: April 29, 2023
Peer-review started: April 29, 2023
First decision: June 1, 2023
Revised: June 14, 2023
Accepted: July 3, 2023
Article in press: July 3, 2023
Published online: July 28, 2023
Processing time: 88 Days and 11.7 Hours
Abstract
BACKGROUND

Malignant hyperthermia (MH) is a hypermetabolic disorder of skeletal muscles triggered by exposure to volatile anesthetics and depolarizing muscular relaxants. It manifests with clinical presentations such as tachycardia, muscle rigidity, hyperpyrexia, and rhabdomyolysis in genetically predisposed individuals with ryanodine receptor or calcium voltage-gated channel subunit alpha1 S mutations. Local anesthetics, such as lidocaine, are generally considered safe; however, complications can arise, albeit rarely. Lidocaine administration has been reported to induce hypermetabolic reactions resembling MH in susceptible individuals. The exact mechanism by which lidocaine might trigger MH is not fully understood. Although some mechanisms are postulated, further research is needed for a better understanding of this.

CASE SUMMARY

We present the case of MH in a 43-year-old male patient with an unknown genetic predisposition following a lidocaine injection during a dental procedure. This case serves as a reminder that while the occurrence of lidocaine-induced MH is rare, lidocaine can still trigger this life-threatening condition. Therefore, caution should be exercised when administering lidocaine to individuals who may be susceptible to MH. It is important to note that prompt intervention played a crucial role in managing the patient’s symptoms. Upon recognizing the early signs of MH, aggressive measures were initiated, including vigorous intravenous normal saline administration and lorazepam. Due to the effectiveness of these interventions, the administration of dantrolene sodium, a specific antidote for MH, was deferred.

CONCLUSION

This case highlighted the significance of vigilant monitoring and swift action in mitigating the detrimental effects of lidocaine-induced MH. Caution should be exercised when administering lidocaine to individuals who may be predisposed to MH. It is very important to be aware and vigilant of the signs and symptoms of MH as early recognition and treatment intervention are important to prevent serious complications to decrease mortality.

Keywords: Malignant hyperthermia; Tachyarrhythmia; Lidocaine; Local anesthesia; Dantrolene sodium; Genetic mutation; Case report

Core Tip: Malignant hyperthermia is preventable in the clinical setting with the use of anesthetics like succinylcholine or inhaled versions like halothane or sevoflurane. Clinical findings like hypercarbia in the operating room or hyperthermia, tachycardia, muscle rigidity, and rhabdomyolysis are the sequela that follows. These symptoms rarely occur with the usage of local anesthetics like lidocaine. Given their wide application in the clinical setting, it is paramount for clinicians to be aware of the likelihood of malignant hyperthermia being caused by local anesthetics and to manage the symptoms as early as possible.