Expert: Dr Ian Jackson - please note UK based - 2/7/2009

Question
My son has had general surgery twice (2/07, 12/07) when he has surgery for chronic exertional compartment syndrome (fasciotomies done on all 4 compartments in each calf). He did quite well after surgery except for urinary retention on his first postoperative day.  On post op day #5 after the first surgery he develeped a significant fever (102f) and was will with fever/sweats, lethargy for apprx. 7 more days. At the time his physician thought he had developed the flu.  When he had his second surgery (fasciotomy on two compartments bilaterally) he did the same thing.  This time he had blood work and was put on an antibiotic but he did not have an elevated white blood count or any other obvious sign of infection.  He stayed ill for almost the same length of time.  He had elevated temperatures, drenching sweats and felt terrible (the antibiotic didn't seem to alter the course when compared to his first postoperative illness).  I know 5 days would be late to have a reaction to anesthesia and I am unsure what drugs he received (both surgeries were done Boise, ID USA).  He is having another surgery next month and is quite frightened about his recovery from the surgical procedure and the anesthesia.  Is there any type of anesthesia reaction that can occur 5 days after surgery?

Answer
Hi there
As you say this is very unusual given the time lag for the onset of his symptoms and this makes it difficult to explain. I suggest you have a chat with the anaesthetic department now well before the planned op to discuss this issue. They can look at the drugs/technique used previously and advise if there is anything that they can do differently.
The other interesting thing is that he has been having unusual surgery - certainly I've never seen this being done in the UK. I have to assume he is quite sporty?
It does make me wonder if he has some form of unusual muscle metabolism and that his muscles are having a reaction to something in the anaesthetic - this is typically called Malignant Hyperthermia but is better named malignant hypermetabolism.
Going against this is the delay factor but I would not rule out something like this. If I was looking after him I would give him an anaesthetic avoiding all the 'trigger agents' and see how he does this time. If he had no problems then I would refer him to a specialised unit for a muscle biopsy (small op under local)
Sorry I ahve no magic answer but I would suggets talking to the anaesthetic department soon.
Kind regards and I hope all is uneventful this time - please let me know how you get on/outcome.
Dr Ian Jackson