Summary
Definition
History and exam
Key diagnostic factors
- exposure to potent inhalation anesthetic and/or succinylcholine
- susceptibility to MH
- previous MH episode
- positive family history
- increased minute ventilation
- elevated core temperature
- muscle rigidity
Other diagnostic factors
- tachycardia
- decreased urine output
- excessive sweating with exercise
- muscle cramps
- spontaneous episodes of severe muscle stiffness
Risk factors
- exposure to potent inhalation anesthetic and/or succinylcholine
- susceptibility to MH
- previous MH episode
- positive family history
- exertional heat illness
Diagnostic tests
1st tests to order
- 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
Tests to consider
- caffeine halothane contracture test (CHCT)
- in vitro contracture test (IVCT)
- genetic testing
- screen for muscle enzyme deficiencies
Treatment algorithm
inhalation anesthetic-induced
exercise- or heat-induced
Contributors
Authors
Christopher M. Edwards, MD
Assistant Professor
Department of Anesthesiology
University of Florida College of Medicine
Gainesville
FL
Declarações
CME volunteers for the Malignant Hyperthermia Association of the United States (MHAUS), including as a consultant for the malignant hyperthermia hotline. CME is co-author of a chapter on malignant hyperthermia in Fuhrman & Zimmerman’s Pediatric Critical Care, 6th ed., Elsevier.
Nikolaus Gravenstein, MD
Professor
Department of Anesthesiology
University of Florida College of Medicine
Gainesville
FL
Declarações
NG is medical adviser/consultant for LifeFlow (410 Medical) and Teleflex, and has received funding from Merck for delivering education lectures to Merck employees. NG is Medical Director of the North American Malignant Hyperthermia Registry.
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. For the past 16 years, BWB received grants from MHAUS to maintain the NAMHR. BWB was the unpaid director of the NAMHR, until Jul 2016. BWB has given lectures and prepared educational materials for her previous employer, the Department of Anesthesiology in the University of Pittsburgh. As of 1 July, 2016, BWB retired from that employment. BWB has published papers and prepared educational materials for MHAUS, with the help of other volunteers for MHAUS. BWB sponsored LM for an award granted by the American Society of Anesthesiologists. This award allowed LM to travel to several medical centers that were active in the diagnosis of MH, as well as to the NAMHR to improve her understanding of this syndrome. This is part of BWB's mentoring of younger anesthesiologists. 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
Declarações
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
Declarações
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
Declarações
JT is an author of a number of references cited in this topic.
Referências
Principais artigos
Hopkins PM, Girard T, Dalay S, et al. Malignant hyperthermia 2020: guideline from the Association of Anaesthetists. Anaesthesia. 2021 May;76(5):655-64.Texto completo Resumo
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.Texto completo Resumo
Larach MG, Localio AR, Allen GC, et al. A clinical grading scale to predict MH susceptibility. Anesthesiology. 1994 Apr;80(4):771-9. Resumo
Hopkins PM, Rüffert H, Snoeck MM, et al. European Malignant Hyperthermia Group guidelines for investigation of malignant hyperthermia susceptibility. Br J Anaesth. 2015 Oct;115(4):531-9.Texto completo Resumo
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.Texto completo Resumo
Artigos de referência
Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
Diagnósticos diferenciais
- Non-MH rhabdomyolysis
- Muscle disuse atrophy
- Myotonia
Mais Diagnósticos diferenciaisDiretrizes
- Malignant hyperthermia 2020
- Consensus guidelines on perioperative management of malignant hyperthermia suspected or susceptible patients from the European Malignant Hyperthermia Group
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