Malignant hyperthermia.
Malignant hyperthermia is a rare autosomal dominant trait that predisposes affected individuals to great danger when exposed to certain anaesthetic triggering agents (such as potent volatile anaesthetics and succinylcholine). A sudden hypermetabolic reaction in skeletal muscle leading to hyperthermia and massive rhabdomyolysis can occur. The ultimate treatment is dantrolene sodium a nonspecific muscle relaxant. Certain precautions should be taken before anaesthesia of patients known to be susceptible to malignant hyperthermia. These include the prohibition of the use of triggering agents, monitoring of central body temperature and expired CO2, and immediate availability of dantrolene. In addition, careful cleansing of the anaesthesia machine of vapours of halogenated agents is recommended. If these measures are taken, the chances of an MH episode are greatly reduced. When malignant hyperthermia-does occur in the operating room, prompt recognition and treatment usually prevent a potentially fatal outcome. The most reliable test to establish susceptibility to malignant hyperthermia is currently the in vitro caffeine-halothane contracture test. It is hoped that in the future a genetic test will be available.
Ben Abraham
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Department of Anaesthesia and Intensive Care, Chaim Sheba Medical Center, Tel Hashomer, Israel.
Adnet
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Glauber
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Perel
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D000758:Anesthesia; D018685:Anesthetics, Inhalation; D002110:Caffeine; D000697:Central Nervous System Stimulants; D003620:Dantrolene / Q000627:therapeutic use*; D006221:Halothane; D006801:Humans; D008305:Malignant Hyperthermia / Q000175:diagnosis* / Q000188:drug therapy* / Q000503:physiopathology; D009125:Muscle Relaxants, Central / Q000627:therapeutic use*
D018685:Anesthetics, Inhalation; D000697:Central Nervous System Stimulants; D009125:Muscle Relaxants, Central; D002110:Caffeine; D003620:Dantrolene; D006221:Halothane