© 2018 Kurt Pfeifer.

MALIGNANT HYPERTHERMIA (MH)

ASSESSMENT

Data Gathering

  • Personal or family history of severe fever, muscle rigidity, or rhabdomyolysis with surgery (MH susceptibility inherited in autosomal dominant fashion)

  • Results of any prior genetic or muscle contracture testing for MH

Risk Stratification [MHAUS guide to MH testing]

  • Testing is time-consuming and may be costly (variable insurance coverage)

  • Gold standard is muscle contracture testing with Caffeine Halothane Contracture Test (CHCT)

    • Sensitivity nearly 100%‚Äč

    • Specificity 80%

    • Done at very few centers

    • Surgical procedure

  • Genetic testing (Ryanodine Receptor [RYR1] gene sequencing) can be done but not all mutations causing MH susceptibility have been identified 

MANAGEMENT

Preoperative Management

  • If time allows and patient wishes to pursue testing to definitively know if they are MH susceptible, testing can be ordered; otherwise, if a patient's personal or family history is suggestive of MH, manage the patient as if they are MH susceptible

  • Proper equipment preparation - MHAUS guide

  • Assure properly stocked MH care - MHAUS guide

Intraoperative Management [MHAUS guide to MH]

  • Avoid these anesthesia medications:

    • Inhaled General Anesthetics

    • Desflurane

    • Enflurane

    • Ether

    • Halothane

    • Isoflurane

    • Methoxyflurane

    • Sevoflurane

    • Succinylcholine

Postoperative Management [MHAUS guide to MH]

  • If no evidence of MH intraoperatively, monitor for minimum of 1-2 hours in PACU before discharge

  • If MH occurs, requires at least 36 hours of ICU monitoring