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An event is serious (based on the ICH definition) when the patient outcome is:
* death
* life-threatening
* hospitalisation
* disability
* congenital anomaly
* other medically important event
A 60-year-old man exhibited lack of efficacy during treatment with remdesivir and off-label dexamethasone for SARS-CoV-2 infection. Subsequently, he developed malignant hyperthermia (MH) during treatment with cisatracurium besilate to induce paralysis for better ventilator compliance [dosages not stated; not all routes stated].
The man, who had medical history of dyslipidaemia and solitary kidney, was admitted due to worsening shortness of breath. Six days prior to the admission, he had tested positive for SARS-CoV-2. Upon admission, a CT angiogram of the chest showed extensive bilateral ground-glass airspace opacities. Therefore, he started receiving treatment with remdesivir and off-label dexamethasone for SARS-CoV-2 infection; however, no improvement was noted in his condition, which was suggestive of lack of drugs effects. Additionally, he received unspecified broad spectrum antibacterials. His respiratory distress worsened, and he failed heated high flow nasal cannula and noninvasive ventilation. Thus, he was intubated and initiated on low tidal volume mechanical ventilatory support. Meanwhile, he started receiving dexmedetomidine, propofol, fentanyl and midazolam for sedation and pain control, and was paralysed with cisatracurium besilate [cisatracurium] infusion for better ventilator compliance. After 16 hours, he developed rapid onset of high-grade fever, tachycardia and increased end-tidal carbon dioxide. Laboratory examinations revealed pH of 7.28, pCO2 of 77mm Hg, HCO3 of 35 mmol/L and creatine kinase of 1003 U/L. Serum creatinine and serum potassium were elevated. Based on these examinations, cisatracurium besilate-associated MH was suspected.
The man's treatment with cisatracurium besilate was discntinued, and he was initiated on cooling blankets. In addition, he was treated with dantrolene. Subsequently, his temperature came down and arterial blood gas improved. His symptoms resolved. Over the course of the following few days, his creatine kinase levels dropped.
Reference
- Sathyanarayanan SP, et al. Cisatracurium-Associated Malignant Hyperthermia During Severe Sars-CoV-2 Infection. American Journal of Therapeutics 28: e590-e591, No. 5, Sep-Oct 2021. Available from: URL: 10.1097/MJT.0000000000001437 [DOI] [PMC free article] [PubMed]