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Malignant hyperthermia

Última revisão: 14 Sep 2025
Última atualização: 08 Oct 2025

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

  • exposure to potent inhalation anesthetic and/or succinylcholine
  • susceptibility to malignant hyperthermia (MH)
  • previous malignant hyperthermia (MH) episode
  • positive family history
  • increased minute ventilation
  • elevated core temperature
  • muscle rigidity
Detalhes completos

Outros fatores diagnósticos

  • tachycardia
  • decreased urine output
  • excessive sweating with exercise
  • muscle cramps
  • spontaneous episodes of severe muscle stiffness
Detalhes completos

Fatores de risco

  • exposure to potent inhalation anesthetic and/or succinylcholine
  • susceptibility to Malignant hyperthermia (MH)
  • previous malignant hyperthermia (MH) episode
  • positive family history
  • exertional heat illness
Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

  • discontinuation of inhalation anesthetic
  • exhaled carbon dioxide, oxygen consumption (inspired-expired oxygen concentration difference)
  • venous blood gases
  • serum electrolytes
  • serum creatinine
  • therapeutic trial of intravenous dantrolene
  • creatine kinase
  • urinalysis
  • urine myoglobin
  • platelets
  • prothrombin time
Detalhes completos

Investigações a serem consideradas

  • caffeine halothane contracture test (CHCT)
  • in vitro contracture test (IVCT)
  • genetic testing
  • screen for muscle enzyme deficiencies
Detalhes completos

Algoritmo de tratamento

AGUDA

inhalation anesthetic-induced

exercise- or heat-induced

Colaboradores

Autores

Christopher M. Edwards, MD

Assistant Professor

Department of Anesthesiology

University of Florida College of Medicine

Gainesville

FL

Declarações

CME declares that he has no competing interests.

Nikolaus Gravenstein, MD

Professor

Department of Anesthesiology

University of Florida College of Medicine

Gainesville

FL

Declarações

NG is a medical adviser/consultant for Teleflex, and has co-developed anesthesia patient safety education courses.

Agradecimentos

Christopher M Edwards and Nikolaus Gravenstein would like to gratefully acknowledge Dr Barbara W. Brandom and Dr Lena Mayes, the previous contributors to this topic.

Declarações

LM declares that she has no competing interests. BWB has been reimbursed by the not-for-profit sponsor of the North American MH Registry (NAMHR), the Malignant Hyperthermia Association of the United States (MHAUS) for attending meetings related to the management of the NAMHR. BWB was the unpaid director of the NAMHR, until Jul 2016. BWB is also an author of a number of references cited in this topic.

Revisores

Henry Rosenberg, MD

Director

Department of Medical Education and Clinical Research

Saint Barnabas Medical Center

Livingstone

NJ

Declarações

HR declares that he has no competing interests.

Philip Hopkins, MD

Professor of Anesthesia

University of Leeds

Academic Unit of Anesthesia

St James's University Hospital

Leeds

UK

利益声明

PH is an author of a number of references cited in this topic.

Thierry Girard, MD

Associate Professor

Perioperative Patient Safety

Department of Biomedicine

University Hospital Basel

Basel

Switzerland

利益声明

TG declares that he has no competing interests.

Joseph Tobin, MD, FAAP, FCCM

Professor and Chairman

Department of Anesthesiology

Wake Forest University School of Medicine

Winston-Salem

NC

利益声明

JT is an author of a number of references cited in this topic.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

参考文献

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

关键文献

Hopkins PM, Girard T, Dalay S, et al. Malignant hyperthermia 2020: guideline from the Association of Anaesthetists. Anaesthesia. 2021 May;76(5):655-64.全文  摘要

Larach MG, Dirksen SJ, Belani KG, et al; Society for Ambulatory Anesthesiology; Malignant Hyperthermia Association of the United States; Ambulatory Surgery Foundation; Society for Academic Emergency Medicine; National Association of Emergency Medical Technicians. Special article: creation of a guide for the transfer of care of the malignant hyperthermia patient from ambulatory surgery centers to receiving hospital facilities. Anesth Analg. 2012 Jan;114(1):94-100.全文  摘要

Rüffert H, Bastian B, Bendixen D, et al. Consensus guidelines on perioperative management of malignant hyperthermia suspected or susceptible patients from the European Malignant Hyperthermia Group. Br J Anaesth. 2021 Jan;126(1):120-30.全文  摘要

European Malignant Hyperthermia Group​. Recognising and managing a malignant hyperthermia crisis (v2024). Nov 2024 [internet publication].全文

Litman RS, Smith VI, Larach MG, et al. Consensus statement of the Malignant Hyperthermia Association of the United States on unresolved clinical questions concerning the management of patients with malignant hyperthermia. Anesth Analg. 2019 Apr;128(4):652-9. 摘要

参考文献

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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  • 指南

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    • Consensus guidelines on perioperative management of malignant hyperthermia suspected or susceptible patients from the European Malignant Hyperthermia Group
    更多 指南
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