Scientific publications

Clinical protocol for the management of malignant hyperthermia

Kollmann-Camaiora A (1), Alsina E (2), Domínguez A (2), Del Blanco B (3), Yepes MJ [SP] (4), Guerrero JL (5), García A (5).
(1) Departamento de Anestesiología y Reanimación, Hospital Universitario La Paz, Madrid, España. 
(2) Departamento de Anestesiología y Reanimación, Hospital Universitario La Paz, Madrid, España.
(3) Departamento de Anestesiología y Reanimación, Hospital Clínico Universitario San Carlos, Madrid, España.
(4) Departamento de Anestesiología y Reanimación, Clínica Universidad de Navarra, Pamplona, Navarra, España.
(5) Departamento de Anestesiología y Reanimación, Hospital Virgen de la Victoria, Málaga, España. 

Magazine: Revista Española de Anestesiología y Reanimación

Date: Sep 12, 0201

Anesthesia and Intensive Care [SP]

ABSTRACT

Malignant hyperthermia is a hypermetabolic syndrome that appears in susceptible patients after exposure to certain anaesthetic drugs (succinylcholine, inhalation anaesthetics). Its incidence in Spain is 1 in 40,000 adults, with a 10% mortality rate.

It is induced by an abnormal regulation of the ryanodine receptors, producing a massive release of calcium from the sarcoplasmic reticulum in the striate muscle. Clinical manifestations include: CO2 increase, tachycardia, haemodynamic instability, metabolic and respiratory acidosis, profuse sweating, hyperpyrexia, CPK increase, myoglobinuria, kidney failure, disseminated intravascular coagulation (DIC), and ending in cardiac arrest. Dantrolene sodium is a ryanodine receptor antagonist, and inhibits the release of intracellular calcium.

Definitive diagnosis is achieved by the exposure of muscle fibres to caffeine and halothane. Protocols can help guarantee a reliable and secure management when this severe event occurs.

CITATION  Rev Esp Anestesiol Reanim. 2016 Sep 12. pii: S0034-9356(16)30080-9. doi: 10.1016/j.redar.2016.06.004

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