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Malignant Hyperthermia – the Hidden Danger

Dimana Mitsova, Aleksandra Stefanova, Elena Stoyanova, Plamen Angelov, Anton Dinkov

Abstract

Introduction: Malignant hyperthermia (MH) is a life-threatening elevation in body temperature usually resulting from a hypermetabolic response to concurrent use of a muscle relaxant and an inhalational general anesthetic. The muscle relaxant involved is usually succinylcholine and the inhalational anesthetic is most often halothane, but other anesthetics such as isoflurane, sevoflurane and desflurane may also be involved. Manifestations can include muscle rigidity, hyperthermia, tachycardia, tachypnea, rhabdomyolysis, and respiratory and metabolic acidosis. The diagnosis is clinical. Patients at risk can be tested for their susceptibility. The highest priority treatments are rapid cooling and aggressive supportive measures.

Materials and Methods: The information for this scientific review was gathered from several articles, all of them written after the year 2013. The articles were found by using the keywords: malignant, hyperthermia, anesthesia, complications.

Results: Malignant hyperthermia affects about 1/20,000 people. Susceptibility is inherited, with autosomal dominant inheritance and variable penetrance. Most often, the causative mutation affects the ryanodine receptor of the skeletal muscles. However, more than 22 other causative mutations have been identified. Malignant hyperthermia may develop during anesthesia or the early postoperative period. Clinical presentation varies depending on the drugs used and the patient’s susceptibility. During an episode of malignant hyperthermia, a medicine called dantrolene, which is a postsynaptic muscle relaxant, is often given.

Conclusion: Malignant hyperthermia is a very serious condition, which must not be neglected. It is often discovered after a person is given anesthesia during surgery. The possibility of developing MH should be taken into consideration before every surgery, because it could lead to a fatal ending.


Keywords

malignant, hyperthermia, anesthesia, inherited, life-threatening


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