AN INVESTIGATIONAL CASE STUDY ON MDMAAND ATRACURIUM INDUCED MALIGNANT HYPERTHERMIA

A 27 year old male was scheduled to undergo open reduction and internal xation (ORIF) with PHILOS plate for left shoulder proximal humerus fracture. Aneasthesia was induced with atracurium. Patient developed tachycardia and fall in saturation within 20 minutes, which was managed conservatively and procedure was continued. During intraoperative period patient developed muscle rigidity on left hand along with hypotension and hyperthermia, which confused the surgeon and anesthesiologist whether it is attributed to the drug or some other genetic factors. Patient underwent rst episode of cardiac arrest after 45 minutes induction of general anaesthesia. He was resuscitated but developed second episode of cardiac arrest after a few minutes. Patient was shifted to MICU, all supportive and resuscitation measures were given. Despite all resuscitative measures, patient could not be revived and expired on post op day 2. Later on postmortem report revealed presence of 3,4- methylenedioxymethamphetamine (MDMA) in blood and body uids. There has only been one evidence of atracurium induced malignant hyperthermia reported before, but the probablity of devoloping hyperthermia in this case was probably high. The aim of this study was to investigate whether MDMAor Atracurium is a trigger of malignant hyperthermia in this patient