Malignant hyperthermia
A life-threatening reaction to certain anesthetics in susceptible individuals.
Malignant hyperthermia is a severe reaction to certain anesthetic drugs used during surgery, involving rapid heart rate, high body temperature, and muscle rigidity.[1] Without prompt treatment, the reaction can cause cardiac arrest, kidney failure, and a blood clotting abnormality.[1] Individuals who are susceptible to malignant hyperthermia may remain unaware of their risk unless they encounter triggering anesthetic agents.[1]
Quick Facts
- Field
- Anesthesiology, critical care medicine
- Symptoms
- Muscle rigidity
- high body temperature
- fast heart rate
- Complications
- Rhabdomyolysis, high blood potassium
- Causes
- Volatile anesthetic agents or succinylcholine in those who are susceptible
- Diagnosis
- Based on symptoms and situation, caffeine-halothane contracture test
- Differential
- Sepsis
- anaphylaxis
- serotonin syndrome
- neuroleptic malignant syndrome
- Prevention
- Avoiding potential triggers in those susceptible
- Treatment
- Dantrolene, supportive care
Facts from the source article.
Key facts and history
A 1982 study confirmed dantrolene's usefulness in humans after further animal studies.[2] The Malignant Hyperthermia Association of the United States hotline was established in 1981 to provide telephone support to clinical teams.[3] Susceptibility can occur due to mutations in the RYR1 gene, which accounts for most cases, or the CACNA1S gene, which causes less than one percent of cases.[1] Denborough and colleagues first identified the syndrome in 1962 while studying an affected family at the Royal Melbourne Hospital.[2]
South African anesthesiologist Gaisford Harrison discovered that dantrolene could treat the condition, publishing his findings in a 1975 article.[2] The MHAUS hotline, which began operations in 1982, has offered round-the-clock access to board-certified anesthesiologists ever since.[3] Approximately half of those with malignant hyperthermia susceptibility lack a mutation in any of the currently identified genes.[1]
What the research sources say
The Genetics Home Reference states that the term malignant in medicine refers to conditions dangerous to one's health.[1] The same source notes that affected individuals may be at increased risk for "awake" malignant hyperthermia triggered by physical activity, often while sick.[1] The Malignant Hyperthermia Association of the United States recommends that for newer anesthesia workstations, flushing with 10 L/min of fresh gas may be required for up to 104 minutes.[4] MHAUS recommends adding charcoal filters to the circuit to remove anesthetic gases, obviating the need for purging the system.[4]
These filters are effective in keeping gas concentration below 5 ppm for up to 12 hours with fresh gas flows of at least 3 L/min.[4] According to the Genetics Home Reference, inherited muscle diseases such as central core disease, multiminicore disease, and STAC3 disorder are linked to malignant hyperthermia susceptibility.[1]
References
- "malignant hyperthermia", Genetics Home Reference, Jan 27, 2017. facts only, no text reused. medlineplus.gov
- Wikipedia, "Malignant hyperthermia" (CC BY-SA 4.0), which cites: "Anaesthesia | the Royal Melbourne Hospital"; Denborough MA, "Malignant hyperthermia. 1962", Anesthesiology, 2008, p. 156–7; Malcolm Whyte. 'Clinical Science in Canberra Hospital' in AJ Proust (ed) History of Medicine in Canberra and Queanbeyan and their Hospitals Brolga Press, Gundar; "Unusual reaction to suxamethonium chloride", British Medical Journal, November 1966, p. 1305; Harrison GG, "Control of the malignant hyperpyrexic syndrome in MHS swine by dantrolene sodium. 1975", Br J Anaesth, October 1998, p. 626–9; discuss en.wikipedia.org
- Wikipedia, "Malignant hyperthermia" (CC BY-SA 4.0), which cites: "Implications of National Anesthesia Workload on the Staffing of a Call Center: The Malignant Hyperthermia Consultant Hotline", A&A Case Reports, 2015, p. 43–6 (original not read by us) en.wikipedia.org
- Malignant Hyperthermia Association of the United States, "Preparing the Anesthesia Machine for MHS Patients", www.mhaus.org. facts only, no text reused. mhaus.org
Each numbered sentence above was checked against the source it cites before publication. Sentences citing Wikipedia adapt text from the English Wikipedia article Malignant hyperthermia (contributors), used under CC BY-SA 4.0; this entry is available under the same licence. Other sources were used for facts only; no text or images are copied from them.
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