Clinical protocol for the management of malignant hyperthermia.

A Kollmann-Camaiora, E Alsina, A Domínguez, B Del Blanco, M J Yepes, J L Guerrero, A García

Journal: Revista espanola de anestesiologia y reanimacion 2018;64(1):32-40

PMID: 27633384

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Abstract

Malignant hyperthermia is a hypermetabolic syndrome that appears in susceptible patients after exposure to certain anaesthetic drugs (succinylcholine, inhalation anaesthetics). Its incidence in Spain is 1 in 40,000 adults, with a 10% mortality rate. It is induced by an abnormal regulation of the ryanodine receptors, producing a massive release of calcium from the sarcoplasmic reticulum in the striate muscle. Clinical manifestations include: CO increase, tachycardia, haemodynamic instability, metabolic and respiratory acidosis, profuse sweating, hyperpyrexia, CPK increase, myoglobinuria, kidney failure, disseminated intravascular coagulation (DIC), and ending in cardiac arrest. Dantrolene sodium is a ryanodine receptor antagonist, and inhibits the release of intracellular calcium. Definitive diagnosis is achieved by the exposure of muscle fibres to caffeine and halothane. Protocols can help guarantee a reliable and secure management when this severe event occurs.

Address: Departamento de Anestesiología y Reanimación, Hospital Universitario La Paz, Madrid, España. Electronic address: [email protected].; Departamento de Anestesiología y Reanimación, Hospital Universitario La Paz, Madrid, España.; Departamento de Anestesiología y Reanimación, Hospital Clínico Universitario San Carlos, Madrid, España.; Departamento de Anestesiología y Reanimación, Clínica Universidad de Navarra, Pamplona, Navarra, España.; Departamento de Anestesiología y Reanimación, Hospital Virgen de la Victoria, Málaga, España.

DOI: 10.1016/j.redar.2016.06.004

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MeSH Terms: Adolescent, Adult, Caffeine, Calcium Signaling, Child, Child, Preschool, Clinical Protocols, Critical Care, Dantrolene, Diagnosis, Differential, Disease Management, Female, Halothane, Humans, Infant, Infant, Newborn, Male, Malignant Hyperthermia, Muscle Contraction, Muscle Fibers, Skeletal, Neuroleptic Malignant Syndrome, Ryanodine Receptor Calcium Release Channel, Serotonin Syndrome