Malignant Hyperthermia
It is a misconception that hyperthermia is the initial presenting sign of MH. Hyperthermia typically occurs later and is absent when the condition is first suspected - Brent Carlson PharmD
HWN Suggests
Malignant Hyperthermia Death Holds Many Lessons
Where did the term MH come from? When the disorder was first formally described, the dramatic and unusual feature of the reaction was an elevation of body temperature to levels incompatible with survival—107-109°F or higher—in medical terms, hyperthermia. Since 80% of patients diagnosed with the disorder died, it was a malignant disorder, hence the name. The reaction was especially impressive because, as a rule, a patient’s body temperature has a tendency to drop during anesthesia.
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Malignant hyperthermia: a review
The essential points in the treatment of an acute MH crisis are the immediate discontinuation of trigger agents, hyperventilation, administration of dantrolene in doses of 2.5 mg/kg repeated pro re nata to limit MH, cooling by all routes available (intravenous saline at 4o C, topical ice to all exposed areas, peritoneal exchange).
Articles of Interest
Diagnosis and management of malignant hyperthermia
A previous apparently uneventful general anaesthetic does not exclude the possibility of a malignant hyperthermia (MH) reaction on subsequent exposure to MH triggering drugs.
Malignant hyperthermia
Malignant hyperthermia (MH) is a pharmacogenetic disorder of skeletal muscle that presents as a hypermetabolic response to potent volatile anesthetic gases such as halothane, sevoflurane, desflurane and the depolarizing muscle relaxant succinylcholine, and rarely, in humans, to stresses such as vigorous exercise and heat.
Malignant Hyperthermia (MH)
Treatment must be initiated empirically, when the MH diagnosis is considered probable. The treatments are fairly benign, so it's generally better to err on the side of treatment.
Malignant Hyperthermia CCC
Dantrolene 2.5mg/kg every 5min (total dose 10mg/kg/day – continuous infusion or treat recurrence (25%)).
Malignant Hyperthermia: An Overview
MH may occur in the operating room or soon afterward, in the initial postoperative period. The presentation of MH varies, and most patients do not develop all of the signs.
The Anesthesia Machine and Malignant Hyperthermia
Preoperative screening for MH susceptible patients would require a massive undertaking to determine who is at risk for an adverse event from exposure to potent inhaled anesthetics. The only treatment is dantrolene sodium and prophylaxis with dantrolene has been discouraged.
Resources
Dantrolene
Dantrolene sodium is a postsynaptic muscle relaxant with multiple indications in the fields of anesthesiology and neurology. While there are many indications for the use of dantrolene, its primary indication, and FDA-approved usage in both children and adults, is for the treatment of malignant hyperthermia: the very rare but life-threatening disorder triggered by general anesthesia.
Malignant Hyperthermia Association of the United States
Learn about Malignant Hyperthermia, and the mission and goals of the Malignant Hyperthermia Association of the United States.
Malignant Hyperthermia Australia & New Zealand
Triggering anaesthetics do not necessarily cause an MH crisis every time someone at risk is given them. MH is hereditary; it is passed on through the family. It affects males and females equally, and can occur in every ethnicity. A person with MH has a 50% chance of passing that risk on to each child that they have.
European Malignant Hyperthermia Group
The European Malignant Hyperthermia (MH) Group was formed in 1983 with the following aims: to provide a forum for discussion between the various European MH investigation centers, to improve, maintain and update the quality of diagnostic standards of MH susceptibility...
NORD
Malignant hyperthermia (MH) is a dominantly inherited disorder of skeletal muscle that predisposes susceptible individuals to a life threatening adverse reaction (fulminant MH event) upon exposure to potent volatile anesthetics (halothane, isoflurane, sevoflurane, desflurane, etc.) and the skeletal muscle relaxant succinylcholine.
StatPearls
Nitrous oxide and xenon, although they are inhaled anesthetics, are not halogenated and have not been implicated in malignant hyperthermia.
