Summary
Definition
History and exam
Key diagnostic factors
- presença de fatores de risco
- exposição a um anestésico inalatório forte e/ou succinilcolina (suxametônio)
- susceptibilidade à HM
- episódio prévio de HM
- história familiar positiva
- ventilação-minuto aumentada
- temperatura central elevada
- rigidez muscular
Other diagnostic factors
- taquicardia
- débito urinário diminuído
- sudorese excessiva com exercício
- cãibras musculares
- episódios espontâneos de rigidez muscular intensa
Risk factors
- exposição a um anestésico inalatório forte e/ou succinilcolina (suxametônio)
- susceptibilidade à HM
- episódio prévio de HM
- história familiar positiva
- doença do esforço por calor
Diagnostic tests
1st tests to order
- descontinuação do anestésico inalatório
- dióxido de carbono exalado, oxigênio e consumo de oxigênio (diferença de concentração do oxigênio inspirado-expirado)
- gasometria venosa
- eletrólitos séricos
- creatinina sérica
- tentativa terapêutica com dantroleno intravenoso
- creatina quinase
- urinálise
- mioglobina urinária
- plaquetas
- tempo de protrombina
Tests to consider
- teste de contratura a cafeína-halotano (TCCH)
- teste de contratura in vitro (TCIV)
- teste genético
- rastreamento de deficiências de enzimas musculares
Treatment algorithm
induzida por anestesia inalatória
induzida pelo exercício ou calor
Contributors
Authors
Christopher M. Edwards, MD
Assistant Professor
Department of Anesthesiology
University of Florida College of Medicine
Gainesville
FL
Disclosures
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
Disclosures
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.
Acknowledgements
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.
Disclosures
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.
Peer reviewers
Henry Rosenberg, MD
Director
Department of Medical Education and Clinical Research
Saint Barnabas Medical Center
Livingstone
NJ
Disclosures
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
Disclosures
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
Disclosures
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
Disclosures
JT is an author of a number of references cited in this topic.
References
Key articles
Hopkins PM, Girard T, Dalay S, et al. Malignant hyperthermia 2020: guideline from the Association of Anaesthetists. Anaesthesia. 2021 May;76(5):655-64.Full text Abstract
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;114:94-100.Full text Abstract
Larach MG, Localio AR, Allen GC, et al. A clinical grading scale to predict MH susceptibility. Anesthesiology. 1994 Apr;80(4):771-9. Abstract
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.Full text Abstract
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.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Rabdomiólise não associada a hipertermia maligna (HM)
- Atrofia muscular por desuso
- Miotonia
More DifferentialsGuidelines
- Malignant hyperthermia 2020
- Consensus guidelines on perioperative management of malignant hyperthermia suspected or susceptible patients from the European Malignant Hyperthermia Group
More Guidelines
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