Frank Wappler, MD
Current Opinion in Anaesthesiology 2010, 23:417–422
Purpose of review
Malignant hyperthermia-susceptible patients have an increased risk during anaesthesia.
The aim of this review is to present current knowledge about pathophysiology and
triggers of malignant hyperthermia as well as concepts for safe anaesthesiological
management of these patients.
Recent findings
Trigger substances and mechanisms have been well defined to date. Anaesthesia can
be safely performed with i.v. anaesthetics, nitrous oxide, nondepolarizing muscle
relaxants, local anaesthetics as well as xenon. Attention must be directed to the
preparation of the anaesthetic machine because modern workstations need longer
cleansing times than their predecessors. Alternatively, activated charcoal might be
beneficial for elimination of volatile anaesthetics. Day case surgery can be performed in
malignant hyperthermia-susceptible patients, if all safety aspects are regarded. Whether
there is an association between malignant hyperthermia susceptibility and other
disorders is still a matter of debate.
Summary
The incidence of malignant hyperthermia is low, but the prevalence can be estimated as
up to 1 : 3000. Because malignant hyperthermia is potentially lethal, it is relevant to
establish management concepts for perioperative care in susceptible patients. This
includes preoperative genetic and in-vitro contracture testing, preparation of the
anaesthetic workstation, use of nontriggering anaesthetics, adequate monitoring,
availability of sufficient quantities of dantrolene and appropriate postoperative care.
Taking these items into account, anaesthesia can be safely performed in susceptible
patients.
