Anesthetic Management in an Emergency Surgical Intervention for Supracondylar Fracture in a Pediatric Patient with Malignant Hyperthermia Susceptibility: A Case Report

A 9-year-old, 40-kg child was admitted for emergency surgery due to a left supracondylar humerus fracture. The patient had no known comorbidities and no previous history of surgery. During the preoperative evaluation, it was learned that the patient’s uncle had died due to malignant hyperthermia (MH) during a surgical procedure. Following this event, family members underwent genetic screening, and the presence of a mutation in the RYR1 gene had been previously identified in the patient. Based on this history, the patient was considered MH-susceptible.

An anesthetic plan avoiding all triggering agents was established, and regional anesthesia was selected as the primary technique. To minimize residual volatile anesthetic contamination, a dedicated anesthesia machine was flushed with high fresh gas flow for one hour and vaporizers were removed.

Sedation was achieved with intravenous ketamine (20 mg) and midazolam (1 mg). Oxygen was administered via a face mask. An ultrasound-guided infraclavicular block was performed using 20 mL of 0.25% bupivacaine, providing adequate surgical anesthesia. Intraoperative hemodynamic and respiratory parameters remained stable.

The surgical procedure was completed without complications. Postoperative analgesia was provided with intravenous paracetamol. No signs or symptoms suggestive of malignant hyperthermia were observed during the perioperative or early postoperative period.