Concepts in the prevention and management of malignant hyperthermia

Abstract

Malignant hyperthermia (MH) is a potentially life-threatening hypermetabolic condition that is triggered in susceptible individuals by several inhalation anesthetic agents and/or succinylcholine. The triggering agents reduce the uptake of calcium from the sarcoplasmic reticulum of skeletal muscle in susceptible patients. The increased cytoplasmic calcium sustains uncontrolled contraction in the skeletal muscles, resulting in the symptoms of MH. 1 Jurkat-Rott K. McCarthy T. Lehmann-Horn F. Genetics and pathogenesis of malignant hyperthermia. Muscle Nerve. 2000; 23: 4 Crossref PubMed Scopus (271) Google Scholar MH is inherited as an autosomal dominant disorder, and most susceptible individuals are asymptomatic until they are exposed to a triggering agent. When exposed to a triggering agent, tachycardia, hypercapnia, tachypnea, hyperthermia, hypermetabolism, acidemia, cardiac dysrhythmias, hypercalcemia, hyperkalemia, elevated creatinine kinase (CK) and transaminases, skin mottling, and muscle rigidity may become evident. If untreated, mortality approaches 70%. 2 Rosenberg H. Fletcher J.E. An update on the malignant hyperthermia syndrome. Ann Acad Med Singapore. 1994; 23: 84 PubMed Google Scholar