Malignant hyperthermia as a rare complication of local lidocaine injection: A case report

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.

Ex-aspirated: A Case of Dental Product Aspiration With Retrieval Methodology and Current Review

Foreign body aspiration is of significant prevalence in the pediatric and young adult populations. After dental work, patients are more likely to develop pulmonary symptoms secondary to aspiration events within the tracheobronchial tree. Herein, we describe the clinical case of a 22-year-old man with a past medical history of epilepsy and tuberous sclerosis who presented to his primary care provider for chronic coughing and wheezing. With symptoms refractory to albuterol and control of allergies, radiography was obtained, revealing a 4.1 cm dental product in the right bronchus. We provide an overview of our retrieval method as well as a comparison of flexible and rigid bronchoscopies and the bronchoscopic tools available.

Necrotizing Pancreatitis Secondary to Hydrochlorothiazide and Alogliptin: A Case Report

Drug-induced pancreatitis occurs rarely but should be considered when more common causes have been ruled out. While simple to treat, mortality increases should it progress to a necrotizing process. Here, we present the case of a patient simultaneously using two drugs associated with pancreatitis, which we considered acted synergistically and consequently worsened the patient's outcome.

The Comparative Assessment of Wellens' Syndrome With Proximal Left Anterior Descending Artery (LAD) Stenosis Versus Right Coronary Artery (RCA) or Circumflex Coronary Artery Stenosis and Its Prevalence: A Systematic Review

Wellens' syndrome is well-known for its critical stenosis of the proximal left anterior descending artery (LAD) with characteristic electrocardiographic findings of biphasic or deeply inverted T waves in V2-V6 under specific diagnostic criteria. Although the syndrome is known as a high-grade LAD lesion, its sequence of events can also be seen with the right coronary artery (RCA) and the left circumflex artery (LCX). This systemic review attempts to expand on these findings while analyzing the prevalence of Wellens' syndrome with the RCA and/or the circumflex artery. This study also comparatively indicated that Wellens' syndrome is seen in RCA and circumflex artery stenoses when present; the indication of the same medical management is warranted for effective treatment and survival. We extracted and analyzed 24 case reports each with an atypical presentation of acute coronary syndrome (ACS) and specific Wellens' syndrome pattern of electrocardiogram (ECG) presentation with critical stenosis in the LAD, RCA, and left circumflex artery. The risk of bias assessment was undertaken using internal risk analysis by utilizing medical libraries and certain search phrases to find research articles with the involvement of the LAD as opposed to the RCA and LCX in Wellens' syndrome. Based on the number of respective primary research articles found, a bias calculation was done on the reported respective coronary artery involvement. The finding of our systemic review confirms that Wellens' syndrome is a precordial lead disease with T wave abnormalities that present with critical stenosis of not only the LAD but also the RCA and circumflex artery. The result of our systemic review affirmed that although most Wellens' syndrome cases reported involve the stenosis of the LAD, the critical occlusion of the RCA and/or the circumflex artery was found with Wellens' syndrome pattern of ECG presentation, meaning that the sequence of events is not limited to the proximal LAD.

A Broken Heart: A Case of Takotsubo Cardiomyopathy

Emotional stress-induced left ventricular dysfunction, also known as Takotsubo cardiomyopathy, is a condition that has become more prevalent since the turn of the century. Seen most commonly in postmenopausal women who experience an acute emotional stressor, its presentation resembles that of acute coronary syndrome with electrocardiogram changes, which is why most patients receive a left heart catheterization revealing clean or nonobstructive coronary arteries.

High molecular weight calmodulin-binding protein is phosphorylated by calmodulin-dependent protein kinase VI from bovine cardiac muscle

A high molecular weight calmodulin-binding protein (HMW CaMBP) from bovine heart cytosolic fraction was purified to apparent homogeneity. A novel CaM-dependent protein kinase was originally discovered when the total CaM-binding protein fraction from cardiac muscle was loaded on a gel filtration column. The CaM-dependent protein kinase was shown by gel filtration chromatography to have an apparent molecular mass of 36,000 daltons. The CaM-dependent protein kinase has been highly purified by sequential chromatography on DEAE-Sepharose Cl 6B (to remove calmodulin), CaM-Sepharose 4B, phosphocellulose, Sepharose 6B gel filtration and Mono S column chromatographies. The highly purified protein kinase stoichiometrically phosphorylated the HMW CaMBP in a Ca2+/CaM-dependent manner. The phosphorylation resulted in the maximal incorporation of 1 mol of phosphate/mol of the HMW CaMBP. The distinct substrate specificity of this protein kinase indicates that it is not related to the known protein kinases (I, II, III, IV and V) that have been already characterized, therefore we would like to designate this novel kinase as a CaM-dependent protein kinase VI.