Updated guide for the management of malignant hyperthermia

This continuing professional development module aims to prepare anesthesiologists for the timely recognition and management of a malignant hyperthermia (MH) reaction, which is crucial for averting its life-threatening complications and ultimately for the patient’s survival.

Malignant hyperthermia is a genetic disorder of skeletal muscle cells affecting myoplasmic calcium homeostasis. It can present with nonspecific signs of a hypermetabolic reaction, which can be fatal if treatment, including administration of dantrolene sodium, is not implemented promptly. Rapid evaluation and rejection of alternative diagnoses can lead to a prompt diagnosis and treatment and therefore will significantly reduce the complications, including renal failure, cardiac dysfunction, disseminated intravascular coagulation, and death. After the reaction, patients should be observed for a minimum of 24 hr because of the possibility of recrudescence. As it is a genetic condition, survivors and their family members should be referred to a specialized MH centre for further testing and counselling.

Objectives of this Continuing Professional Development module:

After reading this module, the reader should be able to:

  1. Demonstrate an understanding of the etiology, pathophysiology, and genetics of malignant hyperthermia.
  2. Define the clinical features of malignant hyperthermia to make a prompt diagnosis.
  3. Describe the steps in the treatment of malignant hyperthermia.
  4. Calculate the recommended required doses of dantrolene for acute as well as post-crisis management of malignant hyperthermia.
  5. Set up the referral of the patient and family members to a malignant hyperthermia specialized centre.

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