MALIGNANT

HYPERTHERMIA
Inherited

autosomal dominant disorder of

skeletal muscle.
Triggered by inhalation anaesthetics &
depolarising muscle relaxants resulting in
Increased release of intercdellular calcium
& activation of various metabolic processes.
Result: Hypermetabolic State.

(MH)
First

described in 1960 by Denborough &

Lowell.
Occurrence: 1:15,000: & 1:50,000
150,000 in adults.
Fulminant MH accounts for less than 10%
of all cases.

Earliest Signs:
Tachycardia: rapid rise in end-tidal C02
concentration (measured by capnograph);
supra-ventricular or ventricular
dysrhythmias; warm, flushed skin; hypoxia
(secondary to increased 02 consumption);
hyperthermia; muscle rigidity (secondary to
sustained muscle contracture);
hyperkalaemia; myoglobinuria (seccondary
to muscle breakdown);

(ES Contd)
Respiratory

& metabolic acidosis; later

renal failure from rhabdomyolysis and
myoglobinuria;
Disseminated intravascular coagulation
(DIC) from muscle necrosis; cyanosis;
hypotension and cardiac arrest.

Management:
Stop

all inhalation anaesthetics &

succinylcholine
Stop Surgery or complete as soon as
possible
Maintain endotracheal intubation and
hyperventilate and maintain on 100% 02
Maintain anaesthesia with IV agents eg.
Propolol and fentanyl.

Management (Cont)
Rapid

continuous infusion IV push of

Dantrolene 2.5 mg/Kg mixed in saline
Repeat doses Q 5 10 minutes until signs
of MH are controlled or until maximum
dose of 10mg/Kg is given.
Mortality is less than 10% if treated with
dantrolene. Before its use in 1979 the
mortality was almost always fatal.

Monitor
Arterial

blood gases; serum electrolytes; a

creatinine kinase level; urine for myoglobin

Symptomatic Treatment:
Sodium

bicarbonate given rapidly to correct

metabolic acidosis
Glucose and insulin to treat hyperkalaemia
IV 0.9 NaCl and lasix given to maintain a
high urine output
Alkalinization of urine to prevent renal
failure in patients with myoglobinuria.

Additional treatment:
Core

and surface cooling with iced saline gastric

lavage and a cooling blanket
Lidocaine or amiodarone to treat ventricular
arrhythmias.Note Calcium-channel blockers
should not be used for treatment of dysrhythmias
because CVS collapse may occur when used with
dantrolene. Observation in ICU for 24hrs because
of re-occurrence even after an initial successful
treatment.

Confirmation
Diagnosis

is confirmed by vastus lateralis

muscle biopsy to evaluate the in vitro
response of the muscle to contraction in the
presence of halothane and caffeine.

Precaution
Patient

to wear a Medic Alert bracelet for

MH
Genetic counseling
Theatres to have a policy and procedures
manual for management of MH
For Additional reading:JACS 2004;
(5):198-811.