After a child died following tonsillectomy surgery at Dar Al-Hekma Hospital in Nasr City, controversy escalated in Egypt between the prosecution’s investigations, the Ministry of Health’s decision to close the hospital, and a statement from its administration that said the death was consistent with a rare syndrome known as “malignant hyperthermia.” So what’s the story? What is this syndrome? Why might a person not know that he is exposed to it?
A decision to close… What happened at “Dar Al-Hekma”?
The Public Prosecution launched an investigation into the death of the child “Adam” after undergoing tonsillectomy surgery at Dar Al-Hekma Hospital, east of Cairo.
The prosecution decided to authorize the burial of the body, assign the Forensic Medicine Authority to perform an autopsy, determine the precise cause of death, and verify the extent of any suspicion of negligence or medical error, in addition to seizing the child’s medical file, according to what Egyptian media reported about the investigations.
Before that, the Ministry of Health and Population issued an urgent decision to close and revoke the hospital, following the death of the child following a tonsillectomy operation that was performed on September 8.
The Ministry said that a committee it formed to examine the incident observed violations related to not following infection control policies, not completing the medical file, and not adhering to recognized medical procedures, and referred the report to the prosecution to complete investigations.
What did the hospital say?
In an official statement, the administration of Dar Al-Hekma Hospital said that its medical council met in the presence of professors and anesthesia consultants at the hospital, and with the participation of anesthesia professors from Egyptian universities, to review the child’s papers and analyze the causes of his death.
The administration said that the participants concluded – after reviewing medical papers before, during and after surgery – that what happened was “completely consistent and consistent” with a case of “malignant hyperthermia”, a rare syndrome associated with an acute response to some anesthetic drugs in people with a genetic predisposition to it.
According to the statement, the surgery took 25 minutes, and the symptoms began when the child woke up, and the hospital said that it dealt with it immediately in the operating room and then in intensive care for 4 days, before the child died.
The hospital administration confirmed that it places the medical files at the disposal of the Public Prosecution, and that it is committed to the results of the ongoing investigations.
What is “malignant hyperthermia”?
Despite its name, “malignant hyperthermia” is not just an extreme increase in body temperature, but rather a rare syndrome that may occur in people with a genetic predisposition to developing it when exposed to certain general anesthetics.
The crisis may begin suddenly. The heartbeat and breathing accelerate, the body temperature rises, and muscle stiffness and disturbances in body functions may occur. If the condition is not detected and treated quickly, it may become life-threatening to the patient.
Why might a person not know that he or she is exposed to it?
A person may carry a genetic susceptibility to infection without showing any signs in his daily life, and he may not know that he is susceptible to it until he undergoes anesthesia.
Also, the fact that a person underwent anesthesia in a previous operation without a problem occurring does not necessarily mean that he is not at risk of infection, as the crisis may not occur every time.
This is why knowing your family history is important. If a family member has previously experienced a severe or unexplained reaction during anesthesia, it is important to inform the medical team of this before any operation.
Can it be detected before the operation?
There is no simple routine test that detects all susceptible people, but there are specialized tests that can help determine susceptibility, including genetic tests and specialized muscle tests.
Genetic tests do not detect all cases, so personal and family history remains an important part of assessing susceptibility.
Can an operation be performed on someone who is susceptible to infection?
Yes, the presence of a predisposition does not mean that surgery is forbidden, but rather it means that the anesthesia team needs to know this predisposition in advance, in order to avoid some anesthetic drugs that trigger a crisis, and to develop an appropriate anesthesia plan.
If “malignant hyperthermia” is suspected during anesthesia, prompt recognition of the condition and initiation of treatment are essential, as there are medical protocols to deal with it and control its complications.
As for the incident of the child “Adam,” determining the cause of death and whether there is medical or administrative responsibility remains within the jurisdiction of the investigations and the competent technical and judicial authorities.
But the case also opened a window on a rare condition that a person may not know that he is exposed to, so it remains one of the most important pieces of information that a patient can carry with him to the operating room: a family history of a severe or unexplained reaction to anesthesia that may be of more importance to the doctor than he expects.