Malignant Hyperthermia

Aka: Malignant Hyperthermia

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II. Definition

  1. Rare, inhalational Anesthetic related rapid rise in Body Temperature, Muscle rigidity, Hypertension and Tachypnea

III. Epidemiology

  1. Rare general Anesthesia complication
  2. Autosomal Dominant inherited defect

IV. Causes

  1. Similar to Neuroleptic Malignant Syndrome (due to Antipsychotics)
  2. Anesthetic agents in combination with genetic predisposition
    1. Inhalational Anesthetics
    2. Succinylcholine

V. Pathophysiology

  1. Ryanodine receptor gene (RYR1) defect effects the Calcium release channel in Muscle
  2. Results in an unregulated increase in skeletal Muscle oxidative metabolism

VI. Signs

  1. Hyperthermia
  2. Muscle Rigidity
  3. Hypertension
  4. Tachypnea

VII. Lab: Abnormalities

  1. Metabolic Acidosis
  2. Respiratory Acidosis
  3. Creatinine Phosphokinase (CPK) increased (Rhabdomyolysis)
  4. Serum Creatinine increased

VIII. Complications

  1. Disseminated Intravascular Coagulation (DIC)
  2. Respiratory Failure
  3. Renal Failure
  4. Cardiovascular Collapse
  5. Rhabdomyolysis

IX. Management

  1. Dantrolene (specific treatment of choice)
    1. Adult: 1 to 3 mg/kg IV
    2. Child: 0.5 to 1 mg/kg IV
  2. Supportive measures (especially until Dantrolene available)
    1. Benzodiazepines
    2. Cooling

X. References

  1. (2016) CALS, 14th Ed, 1:126

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