Caution for Psychiatrists: Malignant Hyperthermia Risks Following Electroconvulsive Therapy

Abstract Background Malignant hyperthermia is a potentially lethal condition triggered by specific anesthetic drugs, especially a depolarizing muscle relaxant of suxamethonium. Despite the frequent use of suxamethonium with electroconvulsive therapy (ECT), there has been no reported case of potentially lethal malignant hyperthermia following ECT. In addition, the time interval between the administration of suxamethonium and the onset of malignant hyperthermia has not been outlined in the context of ECT.Case presentation We present the case of a 79-year-old woman suffering from severe depression, who experienced severe malignant hyperthermia due to suxamethonium administration during ECT sessions. She presented with a high fever of 40.2°C, a tachycardia of 140/min, hypertension with a blood pressure exceeding 200 mmHg, significant muscle rigidity, and impaired consciousness. These symptoms emerged two hours after ECT and reached their peak in less than 24 hours. She was given 60 mg of dantrolene, which quickly reduced the muscular rigidity. Subsequently, she received two additional doses of 20 mg and 60 mg of dantrolene, which brought her fever down to 36.2°C and completely eased her muscle rigidity within two days after ECT.Conclusions This is the first reported case of potentially lethal malignant hyperthermia after ECT. In addition, it highlights the delayed onset of malignant hyperthermia following an ECT procedure, emphasizing the necessity for psychiatrists to recognize its onset even after the treatment. In the light of potentially lethal consequences of malignant hyperthemia, it is critically important for psychiatrists to closely monitor both intraoperative and postoperative patient’s vital signs and characteristic physical presentations, promptly identify any symptomatic emergence, and treat it immediately with dantrolene.