Management of Malignant Hyperthermia (MH)

Abstract

Malignant hyperthermia is a potentially fatal genetic defect characterized by disturbance of calcium level in skeletal muscle. Volatile anesthetics and/or the depolarizing muscle relaxant succinylcholine may trigger this hyper-metabolic muscular syndrome due to uncontrolled sarcoplasmic Ca release via functionally altered Ca release receptors, leading to tachycardia, muscular rigidity, hypoxemia, hypercapnia, acidosis, hyperkalemia, and hyperthermia in susceptible individuals. Survival of affected patients depends crucially on the early recognition of symptoms, and characteristic of MH, and immediate action on the part of the presenting anesthesiologist. Since the clinical presentation of malignant hyperthermia is highly variable, the present study includes 3 cases of MH and highlights the timely identification of symptoms for rescuing the patient. In the first case the patient did not survive due to the late noticing of the disorder, for the second case, the patient was treated and managed. lastly, the third case the treatment was unavailable therefore the patient could not be managed. Clinical symptoms of malignant hyperthermia, and current therapeutic guidelines, as well as adequate management of anesthesia in patients susceptible to malignant hyperthermia, are discussed in this report.