Materiały źródłowe

• #1 Malignant hyperthermia: current approaches to prevention and treatment | Kim | Acta Biomedica Scientifica

  https://www.actabiomedica.ru/jour/article/view/526?locale=en_US

  One of the most serious complications of modern anesthesia is malignant hyperthermia, which is a pharmacogenetic disease phenotype manifested by skeletal muscle hypermetabolism and rhabdomyolysis during or after general anesthesia with the use of inhaled anesthetics and succinylcholine. […] Thus, given the increasing use of inhalation anesthesia by Russian anesthetists, to ensure the safety of patients with regard to the development of malignant hyperthermia, it is possible only in the case of official registration in the domestic dantrolene market. […] Also, in the territory of Russia, a network of relevant consultative and diagnostic centers should be established. These measures will undoubtedly increase the effectiveness of treatment and prevention of severe consequences of this disease in our country.

• #2 Malignant Hyperthermia: A Rare, but Clinically Relevant Disorder with a Genetic Basis | Orthopedic Center for Sports Medicine

  https://nolasportsmedicine.com/malignant-hyperthermia-a-rare-but-clinically-relevant-disorder-with-a-genetic-basis/

  Malignant hyperthermia (MH) is a rare medical emergency that can occur during general anesthetics (Hopkins et al 2021). The reaction has genetic basis that can help physicians associate risk factors. […] While MH is extremely difficult to prevent without a known genetic mutation, collaboration between anesthesiologists and nurses can assess risk factors.

• #3 Malignant Hyperthermia: What It Is, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/17945-malignant-hyperthermia

  Malignant hyperthermia is difficult to prevent unless you know you have the genetic mutation that causes it or you have a family history of the condition and have told your anesthesiologist. If this is the case, your anesthesiologist wont use the known triggers for your anesthesia plan. […] Unfortunately, people often dont know theyre at risk for malignant hyperthermia until it happens to them. […] The good news is that its treatable and even preventable if you know youre at risk for the condition.

• #4 Malignant hyperthermia | UM Health-Sparrow

  https://www.uofmhealthsparrow.org/departments-conditions/conditions/malignant-hyperthermia

  If you have a family history of malignant hyperthermia or a relative who has problems with anesthesia, tell your health care provider or anesthesiologist before surgery or any procedure that requires anesthesia. […] Evaluating your risk of malignant hyperthermia allows your anesthesiologist to avoid certain anesthesia drugs.

• #5 Malignant Hyperthermia | Preop Evaluation

  https://www.preopevalguide.com/malignant-hyperthermia

  Personal or family history of severe fever, muscle rigidity, or rhabdomyolysis with surgery (MH susceptibility inherited in autosomal dominant fashion) […] If time allows and patient wishes to pursue testing to definitively know if they are MH susceptible, testing can be ordered; otherwise, if a patient’s personal or family history is suggestive of MH, manage the patient as if they are MH susceptible […] Proper equipment preparation – MHAUS guide […] Assure properly stocked MH care – MHAUS guide […] Avoid these anesthesia medications: Inhaled General Anesthetics, Desflurane, Enflurane, Ether, Halothane, Isoflurane, Methoxyflurane, Sevoflurane, Succinylcholine […] If no evidence of MH intraoperatively, monitor for minimum of 1-2 hours in PACU before discharge […] If MH occurs, requires at least 36 hours of ICU monitoring.

• #6 Malignant Hyperthermia – Together by St. Jude™

  https://together.stjude.org/en-us/treatment-tests-procedures/symptoms-side-effects/malignant-hyperthermia.html

  Before your child has surgery, your health care team will ask whether anyone in the family has had severe reactions to anesthesia. This information will help the doctor choose the best anesthesia for your child. […] Family history or past personal medical history can also put you at risk for MH. Usually before anesthesia, the anesthesia team will ask if you or your family members have had any anesthesia and if they had any side effects when they were put to sleep. If you or a family member had a reaction during or right after anesthesia, your doctor will take this information into account when choosing which anesthesia medicine you should get. […] Let your doctors know if genetic tests have shown that your child is at increased risk for MH.

• #7 Malignant hyperthermia: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/001315.htm

  Tell your health care provider before having surgery with general anesthesia, if you or anyone in your family has MH. […] Avoid stimulant drugs such as cocaine, amphetamine (speed), and ecstasy. These drugs may cause problems similar to MH in people who are prone to this condition. […] Genetic counseling is recommended for anyone with a family history of myopathy, muscular dystrophy, or MH.

• #8 Advance knowledge and a prepared team make the difference.

  https://www.aorn.org/outpatient-surgery/article/2012-September-clinical-concerns-managing-malignant-hyperthermia

  Malignant hyperthermia is a rare but potentially fatal complication. If a patient is determined to be at risk, it’s almost 100% preventable, and if it presents unexpectedly, immediate action can drastically reduce its mortality. […] Preventing MH begins by identifying patients at risk. As MH is an inherited disorder and often triggered by exposure to certain anesthetics, those compiling medical histories should cover personal and family anesthetic experiences in detail. […] Research has shown that 70% of MH cases are caused by mutations in the gene RYR1. Because genetic testing is available to identify this mutation, it stands to reason that it can truly prevent MH among high-risk patients. […] If a patient with a history of or at high-risk for MH is scheduled for surgery, your anesthesia provider should play a lead role in taking preventive action.

• #9 Malignant Hyperthermia – Injuries; Poisoning – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/injuries-poisoning/heat-illness/malignant-hyperthermia

  Local or regional anesthesia is preferred to general anesthesia when possible. Potent inhalational anesthetics and depolarizing muscular relaxants should be avoided in patients who are susceptible and those with a strong family history. Dantrolene should be available at the bedside. […] Testing for susceptibility to malignant hyperthermia is recommended for people at risk based on a family history of the disorder or a personal history of a severe or incompletely characterized previous adverse reaction to general anesthesia. The caffeine halothane contracture test (CHCT) is the most accurate. It measures the response of a muscle tissue sample to caffeine and halothane. Genetic testing is also easily available but may be limited based on the type of mutation detected.

• #10 susceptibility to malignant hyperthermia 1 | Hereditary Ocular Diseases

  https://disorders.eyes.arizona.edu/category/alternate-names/susceptibility-malignant-hyperthermia-1

  Malignant hyperthermia due to mutations in RYR1 is most commonly inherited as an autosomal dominant trait precipitated by exposure to certain volatile anesthetic agents such as halothane, isoflurane, and enflurane used in association with succinylcholine during general anesthesia. […] The best treatment is prevention by using alternate anesthetic agents if the risk is recognized preoperatively. Temperature should be monitored in all patients undergoing general anesthesia since prompt recognition of hyperthermia is essential. Inhalation agents and succinylcholine must be discontinued and dantrolene sodium should be given promptly. Metabolic abnormalities must be corrected and both external and internal body cooling should be initiated immediately. […] A positive family history of MHS requires pre-anesthesia gene testing but failure to detect a mutation in known genes does not rule out susceptibility.

• #11 Malignant hyperthermia – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/malignant-hyperthermia/diagnosis-treatment/drc-20353752

  If you or someone in your family has malignant hyperthermia susceptibility (MHS) or you think you may be at risk of malignant hyperthermia, it’s important to tell your health care provider and anesthesiologist before you get anesthesia. Drugs that do not trigger malignant hyperthermia may be used as part of your anesthesia. […] Also, check with your health care provider to see if you should have genetic testing to determine if you have a genetic disorder that puts you at risk of malignant hyperthermia. Ask if close family members should also consider genetic testing. […] If you have the genetic disorder MHS that puts you at risk of malignant hyperthermia, wear a medical alert bracelet or necklace. This lets health care providers know of your risk, especially in an emergency, when you may not be able to talk.

• #12 Malignant Hyperthermia: Causes, Triggers, Treatments

  https://www.webmd.com/a-to-z-guides/what-is-malignant-hypertherima

  Theres no treatment to reverse the genetic defect that causes malignant hyperthermia. Knowing if you have the genetic defect can help you avoid emergencies. […] Tell your doctor if youre at risk of experiencing malignant hyperthermia. Theyll make sure to use safe anesthetics during medical treatments. […] A doctor will pay close attention to your temperature and other basic measurements during a procedure with anesthesia. Responding early to changes in these measurements can help prevent malignant hyperthermia emergencies.

• #13 What is MH? – Revonto

  https://revonto.com/about-malignant-hyperthermia/what-is-mh/

  Prevention of MH involves avoidance of the triggering anesthetic agents in patients with a personal or family history of MH. […] Dantrolene sodium for injection can be used preoperatively, and sometimes postoperatively, to prevent or attenuate the development of clinical and laboratory signs of MH in individuals judged to be susceptible to MH. […] It is also indicated preoperatively and sometimes postoperatively, to prevent or attenuate the development of clinical and laboratory signs of malignant hyperthermia in individuals judged to be malignant hyperthermia susceptible. […] Monitoring for early clinical and metabolic signs of malignant hyperthermia is indicated because attenuation of malignant hyperthermia, rather than prevention, is possible.

• #14 Malignant hyperthermia | Antwerp Surgical Training, Anatomy and Research Centre | University of Antwerp

  https://www.uantwerpen.be/en/research-groups/astarc/research/research-groups/anaesthesiology/malignant-hyperthermia/

  Malignant hyperthermia (MH) is a life-threatening, potentially fatal complication of general anesthesia triggered by the commonly used inhalational anesthetics and succinylcholine. […] Patients who are known to be MH susceptible may be anesthetized with regional anesthesia or local anesthesia without problems. If general anesthesia or sedation is required, the potent volatile agents and succinylcholine have to be avoided, and replaced by total intravenous anesthesia with propofol/morphinomimetic/muscle relaxant. Preoperatively, the anesthesia workstation has to be flushed with a fresh gas flow of 10L/min for at least 60 min, and the vaporizer has to be taken out of the circuit. A recent alternative is to use activated charcoal filters which very effectively remove traces of volatile anesthetics from the breathing circuit (VaporClean filters).

• #15 Malignant hyperthermia: a review | Orphanet Journal of Rare Diseases | Full Text

  https://ojrd.biomedcentral.com/articles/10.1186/s13023-015-0310-1

  Preventative measures include preoperative assessment and identification of an inherited association with a known family, managing a patient with a suspected history as MH susceptible until testing is undertaken, an operating theatre list of susceptible names in the community and an indication of MH susceptibility on the anesthetic record audit form, labeling hospital records together with a national alert warning on records, and family education is helpful. […] All patients receiving more than a brief general anesthetic should have their core temperature monitored. […] Young patients (below age 12 approximately) should not receive succinylcholine for elective procedures, in order to avoid the possibility of hyperkalemic response in a patient with undiagnosed muscular dystrophy. […] Patients who are known to be MH susceptible may be anesthetized with regional anesthesia or local anesthesia without problems. If general anesthesia or sedation is required, potent volatile agents and succinylcholine must be avoided. Non-depolarizing muscle relaxants and all intravenous inducing agents are safe to use.

• #16 Malignant hyperthermia – Wikipedia

  https://en.wikipedia.org/wiki/Malignant_hyperthermia

  Where general anesthesia is planned, it can be provided safely by either flushing the machine or using charcoal filters. […] To flush the machine, first remove or disable the vaporizers and then flush the machine with 10 L/min or greater fresh gas flow rate for at least 20 minutes. […] Charcoal filters can be used to prepare an anesthesia machine in less than 60 seconds for people at risk of malignant hyperthermia.

• #16 Malignant hyperthermia – Wikipedia

  https://en.wikipedia.org/wiki/Malignant_hyperthermia

  In the past, the prophylactic use of dantrolene was recommended for MH-susceptible patients undergoing general anesthesia. […] However, multiple retrospective studies have demonstrated the safety of trigger-free general anesthesia in these patients in the absence of prophylactic dantrolene administration. […] After weighing its questionable benefits against its possible adverse effects (including nausea, vomiting, muscle weakness and prolonged duration of action of nondepolarizing neuromuscular blocking agents), experts no longer recommend the use of prophylactic dantrolene prior to trigger-free general anesthesia in MH-susceptible patients. […] Anesthesia for people with known susceptibility to MH requires avoidance of triggering agent concentrations above 5 parts per million (all volatile anesthetic agents and succinylcholine).

• #17 Malignant Hyperthermia – WikiAnesthesia

  https://wikianesthesia.org/wiki/Malignant_Hyperthermia

  Prevention in susceptible patients: […] 1. Machine […] – Change circuit and CO2 absorbent […] – Remove or disable vaporizers […] – Refer to anesthetic machine regarding time required to flush machine (FGF of 10 L/min for 20 minutes) […] – During case, keep flows 10L/min to avoid rebound phenomenon (release of dissolved residual volatile anesthetic agent) […] 2. Monitors […] – Standard ASA monitors, especially temperature and ETCO2 […] 3. Anesthetic […] – Avoid succinylcholine and volatiles […] – All other non-triggering agents are okay (including N2O) […] 4. Emergency […] – Know where to find the MH cart […] – Have dantrolene or rhyanodex available

• #18 Advance knowledge and a prepared team make the difference.

  https://www.aorn.org/outpatient-surgery/article/2012-September-clinical-concerns-managing-malignant-hyperthermia

  The use of certain anesthesia agents must be avoided. Known triggering agents include muscle relaxants, such as the paralytic succinylcholine, and volatile inhalational drugs such as desflurane, sevoflurane and isoflurane. […] Schedule an MH-susceptible patient’s case as the first of the day in order to avoid inadvertent exposure to traces of agents used in other surgeries. […] Prevention is a key defense, but so are prompt recognition and preparedness. […] A well-stocked MH cart and resuscitative devices must be regularly maintained and readily available. At least 18 vials of dantrolene must be immediately available. […] The first dose of dantrolene must be administered as soon as possible, via a large-bore intravenous or central venous line. […] Once stabilized, the post-operative patient should be observed closely and maintained on dantrolene 1mg/kg for 24 to 48 hours.

• #19 Perioperative Management of MH Suspected or Susceptible Patients — European Malignant Hyperthermia Group

  https://www.emhg.org/recommendations-1/2018/2/27/perioperative-management-of-mh-suspected-or-susceptible-patients

  In addition to the guidelines for MH diagnosis the European Malignant Hyperthermia Group has issued the following recommendations. […] We suggest similar premedication for MH suspected or susceptible patients compared with patients with no disposition to develop MH.(weak recommendation, level of evidence 2-) […] Preoperative treatment with dantrolene is not recommended(evidence level 2-). […] Only trigger free anaesthesia should be used in all MH suspected or susceptible patients.(Strong recommendation, best practice statement) […] We recommend standard anaesthesia monitoring in MH suspected or susceptible patients.(weak recommendation, evidence level 2-). […] We suggest MH suspected or susceptible patients receive standard care in the recovery room (PACU) after anaesthesia.(weak recommendation, evidence level 4).

• #20 RYANODEX® | Malignant Hyperthermia Protocol

  https://www.ryanodex.com/mock-drill-video/

  RYANODEX® (dantrolene sodium) for injectable suspension is indicated for the treatment of malignant hyperthermia in conjunction with appropriate supportive measures, and for the prevention of malignant hyperthermia in patients at high risk. […] RYANODEX® is not a substitute for appropriate supportive measures in the treatment of malignant hyperthermia (MH), including discontinuing use of MH-triggering anesthetic agents, managing the metabolic acidosis, instituting cooling when necessary, and administering diuretics to prevent late kidney injury due to myoglobinuria (the amount of mannitol in RYANODEX® is insufficient to maintain diuresis).

• #21

  https://www.nursingcenter.com/cearticle?an=01261775-202104000-00003&Journal_ID=646631&Issue_ID=5834787

  Malignant hyperthermia (MH) is caused by a genetic disorder of the skeletal muscle that induces a hypermetabolic response when patients are exposed to a triggering agent such as volatile inhaled anesthetics or depolarizing neuromuscular blockers. […] The first step in treatment once MH has been identified is to discontinue the offending agent. […] Dantrolene works by interfering with the release of calcium ions from the sarcoplasmic reticulum of skeletal muscle, thus decreasing the calcium ion concentration available to cause continued muscle contraction. It can be used preoperatively as a prophylactic agent for MH, or in an MH crisis. […] When used for prophylaxis, the dose of dantrolene is 2.5 mg/kg intravenously (IV) and should be administered 75 min before anesthesia. […] Because of the known mortality reduction associated with dantrolene use, the MHAUS recommends that dantrolene be available within 10 min of any location where volatile anesthetics or succinylcholine is used.

• #22 Should MHS Patients Be Pretreated With Dantrolene? – MHAUS

  https://www.mhaus.org/faqs/should-mhs-patients-be-pretreated-with-dantrolene/

  Dantrolene prophylaxis is not recommended for most MH-susceptible patients. Dantrolene can worsen muscle weakness in patients with muscle disease and should be used with caution. Therefore, dantrolene prophylaxis may be omitted, provided non-triggering anesthetics are used, there is appropriate monitoring, and an adequate supply of dantrolene is available.

• #23 Dosage and Administration – Revonto

  https://revonto.com/using-revonto/dosage-and-administration/

  As soon as the malignant hyperthermia reaction is recognized, all anesthetic agents should be discontinued; the administration of 100% oxygen is recommended. […] Revonto and/or dantrolene sodium capsules may be administered preoperatively to patients judged malignant hyperthermia susceptible as part of the overall patient management to prevent or attenuate the development of clinical and laboratory signs of malignant hyperthermia. […] The recommended prophylactic dose of Revonto is 2.5 mg/kg, starting approximately 1.25 hours before anticipated anesthesia and infused over approximately 1 hour. This dose should prevent or attenuate the development of clinical and laboratory signs of malignant hyperthermia provided that the usual precautions, such as avoidance of established malignant hyperthermia triggering agents, are followed.

• #24 Malignant hyperthermia | Antwerp Surgical Training, Anatomy and Research Centre | University of Antwerp

  https://www.uantwerpen.be/en/research-groups/astarc/research/research-groups/anaesthesiology/malignant-hyperthermia/

  The only drug approved for the treatment of an episode of MH is dantrolene. This drug was described over 40 years ago and widely used in the management of spasticity before its efficacy in treating MH was discovered. […] Dantrolene acts as a postsynaptic muscle relaxant, and does not inhibit RyR2-receptors which explains why the drug has no negative inotropic effects. […] Overdosing results in CNS depression, hypotension, nausea, vomiting and muscle weakness which lasts for up to 72 hours.

• #25 Malignant Hyperthermia in Animals – Metabolic Disorders – Merck Veterinary Manual

  https://www.merckvetmanual.com/metabolic-disorders/malignant-hyperthermia/malignant-hyperthermia-in-animals

  Malignant hyperthermia (MH) is a potentially fatal pharmacogenetic disorder of skeletal muscle calcium regulation. […] minimizing stress and appropriate anesthetic selection are key for prevention. […] Avoiding triggering agents is key for prevention. […] In susceptible animals, stress before anesthesia should be minimized and anesthetics that are known triggering agents should be avoided. […] Azaperone at 0.52 mg/kg, IM, has been shown to prevent MH due to halothane in susceptible Pietrain pigs. Acepromazine has also been shown to reduce the incidence of MH in pigs. […] Dantrolene (a specific ryanodine receptor antagonist) has proved effective for treatment (13 mg/kg, IV) and prophylaxis (510 mg/kg, PO, prior to anesthesia). […] The development of a DNA test for MH has allowed producers to accurately identify the MH mutation genotypes. Elimination of the MH mutation from breeding stock can reduce the amount of unsuitable PSE pork produced.

• #26 Malignant Hyperthermia Preparedness: Stocking, Drilling, and Offsite Considerations – Anesthesia Patient Safety Foundation

  https://www.apsf.org/article/malignant-hyperthermia-preparedness-stocking-drilling-and-offsite-considerations/

  Malignant hyperthermia (MH) is a rare life-threatening condition that is triggered by commonly used anesthetic medications. Early recognition and treatment is essential to improve survival rates, and being prepared for an MH crisis can decrease clinical response time and the associated morbidity and mortality with the disease. Stocking a dedicated MH cart and routinely performing simulated MH crisis drills can improve the facility and providers’ management. […] We focus on two essential steps in the preparation to manage an MH crisis: stocking a dedicated MH Cart to be used during an acute crisis, and developing an institutional multidisciplinary mock MH drill for anesthesia and operating room personnel. […] The Malignant Hyperthermia Association of the United States (MHAUS) recommends medications and supplies be readily available for use, within 10 minutes of recognizing an MH crisis.

• #27 Malignant Hyperthermia Preparedness: Stocking, Drilling, and Offsite Considerations – Anesthesia Patient Safety Foundation

  https://www.apsf.org/article/malignant-hyperthermia-preparedness-stocking-drilling-and-offsite-considerations/

  Temperature management of MH patients is very important as the risk of death increases with increasing temperature. Following discontinuation of the triggering agent, dantrolene administration is the most important pharmacologic temperature management strategy. […] The utility of medical simulation is well demonstrated and its application to rare medical events can improve familiarity while providing hands-on experience. Each facility is different in their training options, but MHAUS recommends teams perform mock MH drills every year; we provide a few tips to maximize the team’s benefit from these valuable exercises. […] As of today, MHAUS recommends facilities that stock and have the potential to administer any triggering agent, including succinylcholine without volatile agents, should have dantrolene immediately available in the event a patient in that facility develops MH. […] Early recognition and treatment of MH is essential to improve survival rates. Stocking a dedicated MH cart, routinely performing simulated MH crisis drills, and having enough dantrolene stocked can save lives.

• #28

  https://www.aorn.org/outpatient-surgery/article/2021-August-MH-prevention

  While the staff at our small outpatient center performed yearly malignant hyperthermia (MH) simulation training, many of us agreed that we could be doing more. […] If youre in a similar situation, our method could be just what you need to be fully prepared in the event of a real-life MH event. […] The beauty of the role cards is they list all the specific duties each team member is required to complete during an MH emergency. […] Your charge nurse should stay behind the scenes, coordinating response efforts and positioning themselves to let the front desk know exactly when the emergency responders are coming. […] When we started brainstorming ideas, we had a very difficult time finding journal article reviews with MH task cards specific for an ambulatory surgery center. […] Our main drive was creating a successful MH response process for a small surgical center with limited resources.

• #29

  https://link.springer.com/article/10.1007/s005400200026

  To assess the preparedness of hospitals in Japan for cases of malignant hyperthermia (MH). […] The results of the survey revealed that some hospitals had inadequate monitoring methods and a lack of prepared dantrolene for cases of MH under general anesthesia. We recommend that essential monitors be deployed and adequate preparations of dantrolene be maintained for effective early diagnosis and treatment of MH.

• #30 Act Fast When Dantrolene Is Needed for Malignant Hyperthermia

  https://www.linkedin.com/pulse/act-fast-when-dantrolene-needed-malignant-scott-wolter

  There’s no time to spare when a patient needs treatment for malignant hyperthermia. […] Document this info to help ensure preventive measures are taken in these patients. For example, certain anesthetics may need to be avoided if a patient at risk for malignant hyperthermia requires surgery. […] Alert your purchaser if a malignant hyperthermia cart or kit is used. They’ll need to keep at least 36 vials of Dantrium or Revonto or 3 vials of Ryanodex…enough to treat an average-sized adult…in-house at all times. […] Ensure used carts or kits are promptly and properly refilled and replaced…and that all carts or kits are kept in-date. […] Get our new chart, Malignant Hyperthermia Prevention and Treatment, for more on managing carts or kits, med prep, and mock drills.

• #31 Treating Malignant Hyperthermia: What You Should Know

  https://www.healthline.com/health/malignant-hyperthermia-treatment

  Malignant hyperthermia is a condition thats often triggered by certain anesthesia drugs and can be life threatening. […] Malignant hyperthermia is typically triggered by drugs used as part of the anesthesia process during a surgical procedure. […] Before anesthesia begins, certain measures are taken to make it easy to quickly treat malignant hyperthermia should it arise. […] The operating room will also have processes in place like hypothermia blankets or cold IV fluids to quickly cool the patient. […] Use of the triggering drugs will immediately be stopped, and extra oxygen will be supplied through a mask or tube. Dantrolene, the only FDA-cleared medication for treating malignant hyperthermia, will be given to the individual. […] After stopping the triggering drugs and administering dantrolene, medical staff will treat any of the symptoms or complications that have arisen from the malignant hyperthermia.

• #32 Treating Malignant Hyperthermia: What You Should Know

  https://www.healthline.com/health/malignant-hyperthermia-treatment

  Afterward, the healthcare professional is encouraged to also report the episode to the North American Malignant Hyperthermia Registry of the Malignant Hyperthermia Association of the United States (MHAUS). […] Once signs of malignant hyperthermia are identified, its important for the surgical team to stop use of the triggering drugs, administer dantrolene, and treat any complications or symptoms that malignant hyperthermia has brought on. […] Malignant hyperthermia is a life threatening condition that needs to be treated immediately. […] Treating this condition includes stopping use of the triggering drugs, administering dantrolene, and addressing any complications or symptoms brought on by the malignant hyperthermia.

• #33 What evidence-based interventions are recommended to alleviate hyperthermia associated with Malignant Hyperthermia? – MHAUS

  https://www.mhaus.org/healthcare-professionals/mhaus-recommendations/what-evidence-based-interventions-are-recommended-to-alleviate-hyperthermia-associated-with-malignant-hyperthermia/

  The most important treatment of Malignant Hyperthermia (MH) is discontinuing MH triggering agents, hyperventilation, and timely administration of dantrolene. However, prolonged hyperthermia worsens patients’ outcomes and should also be treated when occurs. […] Many experts believe that hyperthermia is a sign of inadequate physiological treatment and clinicians’ priority should be to stop MH with dantrolene and adequately treat hypercarbia and acidosis before focusing time and efforts on thermal management (personal communication, Dr. Daniel Sessler). It is therefore important to prioritize cooling approaches based on efficiency, ease of use, and safety. […] Cooling should never distract from dantrolene administration and hyperventilation. Most patients treated promptly with dantrolene and hyperventilation do not become seriously hyperthermic or necessitate active cooling. Active cooling should be used with care since there can be a substantial after-drop, depending on the cooling technique, duration of application, and body heat distribution; cooling should thus be discontinued when core temperature decreases to 38°C.

• #34 What evidence-based interventions are recommended to alleviate hyperthermia associated with Malignant Hyperthermia? – MHAUS

  https://www.mhaus.org/healthcare-professionals/mhaus-recommendations/what-evidence-based-interventions-are-recommended-to-alleviate-hyperthermia-associated-with-malignant-hyperthermia/

  External cooling methods such as circulating-water mattresses or ice packs should be considered first. If external cooling is insufficient, an easy, effective, and safe next cooling strategy is to infuse 20 mL/kg of refrigerated intravenous fluid. Other treatments should rarely be necessary, but peritoneal lavage is probably the safest and most effective of the invasive approaches if the peritoneum is already open or the patient is in an emergency department with the requisite equipment and skills.

• #35 Perioperative Management of MH Suspected or Susceptible Patients — European Malignant Hyperthermia Group

  https://www.emhg.org/recommendations-1/2018/2/27/perioperative-management-of-mh-suspected-or-susceptible-patients

  MH susceptible patients may be anaesthetized in outpatient settings avoiding all volatile anaesthetics and succinylcholine, following national guidelines for ambulant general anaesthesia.(weak recommendation, level of evidence 4) […] There is no need for any specific pre- or postoperative blood samples in MH susceptible patients.(weak recommendation, evidence level 4)

• #36 Dosage and Administration – Revonto

  https://revonto.com/using-revonto/dosage-and-administration/

  Dantrolene sodium capsules, 4 to 8 mg/kg/day, in four divided doses should be administered for 1 to 3 days following a malignant hyperthermia crisis to prevent recurrence of the manifestations of malignant hyperthermia. […] It is also indicated preoperatively and sometimes postoperatively, to prevent or attenuate the development of clinical and laboratory signs of malignant hyperthermia in individuals judged to be malignant hyperthermia susceptible.

• #37 Malignant hyperthermia Guide: Causes, Symptoms and Treatment Options

  https://www.drugs.com/health-guide/malignant-hyperthermia.html

  It is not practical to test for this condition in all people who are scheduled for surgery. However, some people should be tested before surgery. Or, they should avoid anesthetics that are known to cause this condition. […] If you do not have a family history of malignant hyperthermia, your first episode may not be predictable or preventable. […] Once you have been diagnosed with the disorder, further episodes can be prevented. Notify your health care professional before you undergo any surgery or office-based procedure. That way, your doctor or dentist can avoid using succinylcholine or high-risk anesthetics. […] You don’t have to avoid surgery altogether. Many safe alternative anesthetics are available. If you know that you are susceptible to malignant hyperthermia, consider wearing a medical alert tag. This tag will advise health care personnel about your condition during an emergency.

• #38 Malignant hyperthermia Guide: Causes, Symptoms and Treatment Options

  https://www.drugs.com/health-guide/malignant-hyperthermia.html

  If you plan to travel outside the United States, you can contact the Malignant Hyperthermia Association of the United States (MHAUS). MHAUS will help to determine whether doctors at your travel destination are aware of malignant hyperthermia and equipped to treat it. This is a sensible precaution because it is a rare disease.

• #39 Malignant Hyperthermia: Is your OR really ready? | OR Today

  https://ortoday.com/malignant-hyperthermia-is-your-or-really-ready/

  Malignant Hyperthermia (MH) is just one of these events that may occur without warning in susceptible individuals receiving certain triggering anesthetics. […] The high risk associated with MH makes it imperative for organizations to prepare their staff with the knowledge, skills, competencies, equipment, and resources to immediately recognize and respond to MH emergencies and ensure optimal patient outcomes. […] Establish policies and procedures that are evidence-based and follow national standards of practice. The organization’s policies must address early identification of clinical deterioration, management of malignant hyperthermia, and create MH kits or require supplies and equipment on emergency carts for an MH emergency. […] With malignant hyperthermia, speed is of the essence. Organizational leadership must make MH preparedness a priority to protect patients from the devastating outcomes that can result from an MH crisis. Providers and staff must be trained to quickly recognize and competently manage an MH event. This includes knowing what supplies, equipment, and medications are needed, and how to access, prepare, and administer them efficiently and without delay.

• #40 Malignant hyperthermia susceptibility: Evaluation and management – UpToDate

  https://www.uptodate.com/contents/susceptibility-to-malignant-hyperthermia-evaluation-and-management

  Malignant hyperthermia susceptibility (MHS) may arise de novo, though it is most often inherited in an autosomal dominant fashion. MHS is suspected in individuals with a history of a clinical event indicative of an acute MH crisis or with a family history of susceptibility. The mainstay of prevention is the identification of these genetically susceptible individuals. Avoidance of anesthetic triggers in MHS patients and prompt administration of dantrolene when an acute event occurs have reduced the mortality associated with MH from historic rates of 70 percent to <10 percent. [...] This topic will review the genetic basis and testing for MHS and the safe administration of anesthesia to MHS patients.

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