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Original ArticleOpen Access
Drug-Induced Hyperthermia and Rhabdomyolysis During the Peri operative Period : Report of Three Patient
Vorrakitpokatorn P 
,
Limsakul A
,
Limsakul A Drug-induced hyperthermia is one condition that anesthesiologists may meet even though
it is uncommon, it is life threatening. We report 3 cases of patients at Siriraj Hospital, Mahidol Uni-
versity who developed drug-induced hyperthermia and rhabdomyolysis from different mechanisms.
In two of them, the diagnosis was suspected malignant hyperthermia. Rigidity, hyperthermia and
tachyarrhythmia developed just after inhalation induction (halothane and sevoflurane) and intubation
with succinylcholine. The other case was the result of amphetamine abuse. He also had received both
succinylcholine and inhalation agent (isoflurane) but no obvious signs or symptoms were detected
during anesthesia. He developed a gradual increase in fever over 13 hours post operation and com-
plained of muscle pain (with leg muscle cramps). All of them showed a marked increase in muscle
enzymes and had rhabdomyolysis. As a result of early detection and early manangement, these three
patients survived without any permanent damage to vital organs. We conclude that Thai anesthesio-
logists should be more aware and alert to drug-induced hyperthermia especially as nowadays
many teenagers abuse stimulant drugs and "triggering" drugs as antidepressant or serotonin reuptake
inhibitors are prescribed more frequently. Early detection and management will decrease morbidity
and mortality.
Key word
: Drug Abuse, Malignant Hyperthermia, Amphetamine, Rhabdomyolysis
it is uncommon, it is life threatening. We report 3 cases of patients at Siriraj Hospital, Mahidol Uni-
versity who developed drug-induced hyperthermia and rhabdomyolysis from different mechanisms.
In two of them, the diagnosis was suspected malignant hyperthermia. Rigidity, hyperthermia and
tachyarrhythmia developed just after inhalation induction (halothane and sevoflurane) and intubation
with succinylcholine. The other case was the result of amphetamine abuse. He also had received both
succinylcholine and inhalation agent (isoflurane) but no obvious signs or symptoms were detected
during anesthesia. He developed a gradual increase in fever over 13 hours post operation and com-
plained of muscle pain (with leg muscle cramps). All of them showed a marked increase in muscle
enzymes and had rhabdomyolysis. As a result of early detection and early manangement, these three
patients survived without any permanent damage to vital organs. We conclude that Thai anesthesio-
logists should be more aware and alert to drug-induced hyperthermia especially as nowadays
many teenagers abuse stimulant drugs and "triggering" drugs as antidepressant or serotonin reuptake
inhibitors are prescribed more frequently. Early detection and management will decrease morbidity
and mortality.
Key word
: Drug Abuse, Malignant Hyperthermia, Amphetamine, Rhabdomyolysis
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