Anesthesiologists' Nightmare: Malignant Hyperthermia

99% boredom and 1% PANIC is the adage for the speciality. PREMIUM CONTENT subscriber access

Malignant Hyperthermia: Picture an emergency where an anesthetized patient’s temperature unexpectedly rises to over 104 degrees Fahrenheit due to hypermetabolic acidotic chemical changes in the patient’s skeletal muscles. The disease requires rapid diagnosis and treatment with the antidote dantrolene, as well as acute medical measures to decrease temperature, acidosis, and high blood potassium levels which can otherwise be fatal. - ConsultantAnesthesiologist

When I was an FDA Medical Officer, I worked in both the Cardio-Renal and the Anesthesia-Critical Care Divisions. And since my bench research had involved calcium channels, Malignant Hyperthermia (MH) was added to my portfolio of applications. So, besides a panic-inducing nightmare for anesthesiologists, what is this syndrome?

Malignant hyperthermia is a rare, life-threatening, autosomal-dominant inherited disorder that may lead to metabolic crisis of skeletal muscle in susceptible patients upon exposure to triggering agents — e.g. volatile halogenated anesthetics or depolarizing muscle relaxants. In everyday life, most MH-susceptible (MHS) individuals do not suffer symptoms. So there usually is no prior warning sign and every anesthesiologist must recognize the symptoms of an MH episode asap and start appropriate treatment without delay.

Family members of patients who suffer from malignant hyperthermia should be educated on the genetic aspect of the disease. See: The Malignant Hyperthermia Association of the United States (MHAUS)

MHAUS 24-hour hotline is (800) MH-HYPER or (800) 644-9737.