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Lebedinskii K.M.

North-Western State Medical University n.a. Mechnikov, Federal Research;
Clinical Center of Intensive Care Medicine and Rehabilitology

Prokopiev G.G.

Russian National Research Medical University named after N. I. Pirogova;
Scientific Practical Center for Specialized Pediatric Medical Care named after. V. F. Voino-Yasenetsky

Stepanenko S.M.

Russian National Research Medical University named after N. I. Pirogova

Dunts P.V.

Regional Clinical Hospital No 2

Molchanov I.V.

Russian Medical Academy for Continuous Professional Education

Ovechkin A.M.

Sechenov First Moscow State Medical University

Aleksandrovich Yu.S.

Children’s Scientific Clinical Center for Infectious Diseases

Lomivorotov V.V.

Penn State Health Milton S. Hershey Medical Center

Shen N.P.

Tyumen State Medical Academy

Trembach A.V.

Kuban State Medical University;
Children's Regional Clinical Hospital

Zolotukhin K.N.

Republican Clinical Hospital named after. G. G. Kuvatova;
Bashkir State Medical University

Pichugin V.V.

Privolzhsky Research Medical University

Boronina I.V.

Voronezh State Medical University named after. N. N. Burdenko;
Voronezh Regional Clinical Hospital No. 1

Diordiev A.V.

Russian National Research Medical University named after N. I. Pirogova;
Scientific Practical Center for Pediatric Psychoneurology

Rostovtsev S.I.

Krasnoyarsk State Medical University named after V.F. Voino-Yasenetsky

Malignant hyperthermia due to anaesthesia

Authors:

Lebedinskii K.M., Prokopiev G.G., Stepanenko S.M., Dunts P.V., Molchanov I.V., Ovechkin A.M., Aleksandrovich Yu.S., Lomivorotov V.V., Shen N.P., Trembach A.V., Zolotukhin K.N., Pichugin V.V., Boronina I.V., Diordiev A.V., Rostovtsev S.I.

More about the authors

Journal: Russian Journal of Anesthesiology and Reanimatology. 2023;(6): 6‑18

DOI: 10.17116/anaesthesiology20230616

Read: 9136 times

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Table of contents

MALIGNANT HYPERTHERMIA DUE TO ANAESTHESIA
MALIGNANT HYPERTHERMIA DUE TO ANAESTHESIA

To cite this article:

Lebedinskii KM, Prokopiev GG, Stepanenko SM, et al. . Malignant hyperthermia due to anaesthesia. Russian Journal of Anesthesiology and Reanimatology. 2023;(6):6‑18. (In Russ.)
https://doi.org/10.17116/anaesthesiology20230616

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Recommended articles:
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Abstract:

Clinical guidelines address malignant hyperthermia, a rare pharmacogenetic syndrome triggered by volatile inhalational anesthetics and suxamethonium. Modern data concerning the mechanism of malignant hyperthermia development are presented, issues of syndrome clinical presentation and diagnosis are highlighted. Practical algorithm for anesthesiologist in case of malignant hyperthermia crisis is given, recommendations for identifying life-threatening syndromes and methods for their correction are presented. Prevention measures are also described. Medical care quality assessment criteria for the management of malignant hyperthermia patients are indicated.

Keywords:

malignant hyperthermia
rhabdomyolysis
dantrolene

Authors:

Lebedinskii K.M.

North-Western State Medical University n.a. Mechnikov, Federal Research;
Clinical Center of Intensive Care Medicine and Rehabilitology

Prokopiev G.G.

Russian National Research Medical University named after N. I. Pirogova;
Scientific Practical Center for Specialized Pediatric Medical Care named after. V. F. Voino-Yasenetsky

Stepanenko S.M.

Russian National Research Medical University named after N. I. Pirogova

Dunts P.V.

Regional Clinical Hospital No 2

Molchanov I.V.

Russian Medical Academy for Continuous Professional Education

Ovechkin A.M.

Sechenov First Moscow State Medical University

Aleksandrovich Yu.S.

Children’s Scientific Clinical Center for Infectious Diseases

Lomivorotov V.V.

Penn State Health Milton S. Hershey Medical Center

Shen N.P.

Tyumen State Medical Academy

Trembach A.V.

Kuban State Medical University;
Children's Regional Clinical Hospital

Zolotukhin K.N.

Republican Clinical Hospital named after. G. G. Kuvatova;
Bashkir State Medical University

Pichugin V.V.

Privolzhsky Research Medical University

Boronina I.V.

Voronezh State Medical University named after. N. N. Burdenko;
Voronezh Regional Clinical Hospital No. 1

Diordiev A.V.

Russian National Research Medical University named after N. I. Pirogova;
Scientific Practical Center for Pediatric Psychoneurology

Rostovtsev S.I.

Krasnoyarsk State Medical University named after V.F. Voino-Yasenetsky

Close metadata

References:

  1. Zhou J, Nozari A, Bateman B, Allen PD, Pessah IN. Neuromuscular Disorders Including Malignant Hyperthermia and Other Genetic Disorders. In: Miller’s Anesthesia. 2-Volume Set 9th Edition. Elsevier; 2020:1113-1144.
  2. Rüffert H, Bastian B, Bendixen D, Girard T, Heiderich S, Hellblom A, Hopkins PM, Johannsen S, Snoeck MM, Urwyler A, Glahn KPE; European Malignant Hyperthermia Group. European Malignant Hyperthermia Group. Consensus guidelines on perioperative management of malignant hyperthermia suspected or susceptible patients from the European Malignant Hyperthermia Group. British Journal of Anaesthesia. 2021;126(1):120-130.  https://doi.org/10.1016/j.bja.2020.09.029
  3. Johnson C, Edlemann KJ. Malignant hyperthermia: A review. Journal of Perinatology. 1992;12(1):61-71. 
  4. Levitt RC. Prospects for the diagnosis of malignant hyperthermia susceptibility using molecular genetic approaches. Anesthesiology. 1992;76:1039-1048. https://doi.org/10.1097/00000542-199206000-00025
  5. MacLennan DH, Phillips MS. Malignant hyperthermia. Science. 1992; 256(5058):789-794. 
  6. Williams CH, Lasley JH. The mode of inheritance of the fulminant hyperthermia stress syndrome in swine. In: Henschel EO, ed. Malignant Hyperthermia: Current Concepts. New York, Appleton-Century-Crofts; 1977:141. 
  7. Bell C, Kain ZN, ed. The Pediatric Anesthesia Handbook. 2nd Edition. St. Louis, Mosby-Year Book; 1997;485-500. 
  8. Wappler F. Malignant hyperthermia. European Journal of Anesthesiology. 2001;18(10):632-652.  https://doi.org/10.1046/j.1365-2346.2001.00888.x
  9. Hopkins PM. Malignant hyperthermia: pharmacology of triggering. British Journal of Anaesthesia. 2011;107:48-56. 
  10. Glahn KP, Ellis FR, Halsall PJ, Müller CR, Snoeck MM, Urwyler A, Wappler F; European Malignant Hyperthermia Group. Recognizing and managing a malignant hyperthermia crisis: guidelines from the European Malignant Hyperthermia Group. British Journal of Anaesthesia. 2010;105:417-420.  https://doi.org/10.1093/bja/aeq243
  11. Recommandations d’Experts pour le Risque d’ l’Hyperthermie Maligne en Anesthésie Réanimation, Société Française d’Anesthésie et de Réanimation. 2013. Accessed July 16, 2023. https://sfar.org/wp-content/uploads/2015/10/2_SFAR_HyperthermieMaligne.pdf
  12. Glahn KPE, Bendixen D, Girard T, Hopkins PM, Johannsen S, Rüffert H, Snoeck MM, Urwyler A; European Malignant Hyperthermia Group. Availability of dantrolene for the management of malignant hyperthermia crises: European Malignant Hyperthermia Group guidelines. British Journal of Anaesthesia. 2020;125:133e40. https://doi.org/10.1016/j.bja.2020.04.089
  13. Prise en charge de l’Hyperthermie Maligne. Actualisation de recommandations de Pratiques Professionnelles, Société Française d’Anesthésie et de Réanimation. 2019. Accessed July 16, 2023. https://sfar.org/download/rpp-hyperthermie-maligne/?wpdmdl=24495&refresh=64b3dba8732861689508776
  14. Preventing Malignant Hyperthermia. An Anesthesia Protocol Malignant Hyperthermia Association of the United States (MHAUS). 1993.
  15. Gronert GA. Human malignant hyperthermia: Awake episodes and correction with dantrolene. Anesthesia and Analgesia. 1980;59(5):377-378. 
  16. Strazis KP, Fox AW. Malignant hyperthermia: A review of published cases. Anesthesia and Analgesia. 1993;77(2):297-304.  https://doi.org/10.1213/00000539-199308000-00014
  17. Britt BA. Recent advances in malignant hyperthermia. Anesthesia and Analgesia. 1972;51(5):841-850. 
  18. Relton JE, Britt BA, Steward DJ. Malignant hyperpyrexia. British Journal of Anaesthesia. 1973;45(3):269-275.  https://doi.org/10.1093/bja/45.3.269
  19. Rosenberg H, Fletcher JE. Malignant hyperthermia. In: Barash PG, ed. ASA Refresher Courses in Anesthesiology. Vol 14. Philadelphia, JB Lippincott Co.; 1986:207-216. 
  20. Kim D-C. Malignant hyperthermia. Korean Journal of Anesthesiology. 2012;63(5):391-401. 
  21. Ording H. Incidence of malignant hyperthermia in Denmark. Anesthesia and Analgesia. 1985;64(7):700-704. 
  22. Rosenberg H, Davis M, James D, Pollock N, Stowell K. Malignant hyperthermia. Orphanet Journal of Rare Diseases. 2007;2:21.  https://doi.org/10.1186/1750-1172-2-21
  23. Brady JE, Sun LS, Rosenberg H, Li G. Prevalence of malignant hyperthermia due to anesthesia in New York State 2001-2005. Anesthesia and Analgesia. 2009;109(4):1162-1166. https://doi.org/10.1213/ane.0b013e3181ac1548
  24. Mayhew JF, Rudolph J, Tobey RE. Malignant hyperthermia in a six month old infant: A case report. Anesthesia and Analgesia. 1978;57(2):262.  https://doi.org/10.1213/00000539-197803000-00018
  25. Schmitt HP, Simmendinger HJ, Wagner H, et al. Severe morphological changes in skeletal muscles of a five-month old infant dying from an anesthetic complication with general muscle rigidity. Neuropädiatrie. 1975;6:102. 
  26. Heiman-Patterson TD, Natter HM, Rosenberg HR, Fletcher JE, Tahmoush AJ. Malignant hyperthermia susceptibility in x-linked muscle dystrophies. Pediatric Neurology. 1987;2:356. 
  27. Schulman S. Malignant hyperthermia and pediatric anesthesia. Seminars in Anesthesia. 1993;12:54-64. 
  28. Stamm DS, Aylsworth AS, Stajich JM, Kahler SG, Thorne LB, Speer MC, Powell CM. Native American myopathy: congenital myopathy with cleft palate, skeletal anomalies, and susceptibility to malignant hyperthermia. American Journal of Medical Genetics. A. 2008;146A:1832e41.
  29. Brownell AKW. Malignant hyperthermia: Relationship to other diseases. British Journal of Anaesthesia. 1988;60:303-308.  https://doi.org/10.1093/bja/60.3.303
  30. Klingler W, Rueffert H, Lehmann-Horn F, Girard T, Hopkins PM. Core myopathies and the risk of malignant hyperthermia. Anesthesia and Analgesia. 2009;109:1167-1173. https://doi.org/10.1213/ANE.0b013e3181b5ae2d
  31. Dlamini N, Voermans NC, Lillis S, Stewart K, Kamsteeg EJ, Drost G, Quinlivan R, Snoeck M, Norwood F, Radunovic A, Straub V, Roberts M, Vrancken AF, van der Pol WL, de Coo RI, Manzur AY, Yau S, Abbs S, King A, Lammens M, Hopkins PM, Mohammed S, Treves S, Muntoni F, Wraige E, Davis MR, van Engelen B, Jungbluth H. Mutations in RYR1 are a common cause of exertional myalgia and rhabdomyolysis. Neuromuscular Disorders: NMD. 2013;23:540-548.  https://doi.org/10.1016/j.nmd.2013.03.008
  32. Wappler F, Fiege M, Steinfath M, Agarwal K, Scholz J, Singh S, Matschke J, Schulte Am Esch J. Evidence for susceptibility to malignant hyperthermia in patients with exercise-induced rhabdomyolysis. Anesthesiology. 2001;94(1):95-100.  https://doi.org/10.1097/00000542-200101000-00019
  33. Kolb ME, Horne ML, Martz R. Dantrolene in human malignant hyperthermia. Anesthesiology. 1982;56(4):254-262.  https://doi.org/10.1097/00000542-198204000-00005
  34. Kaplan RF. Malignant hyperthermia, ASA Refresher Courses in Anesthesiology. Philadelphia, JB Lippincott Co.; 1994.
  35. Hannallah RS, Kaplan RF. Jaw relaxation after a halothane/succinylcholine sequence in children. Anesthesiology. 1994;81(1):99-103.  https://doi.org/10.1097/00000542-199407000-00015
  36. Larach MG, Rosenberg H, Larach DR, Broennle AM. Prediction of malignant hyperthermia susceptibility by clinical signs. Anesthesiology. 1987;66(4):547-550.  https://doi.org/10.1097/00000542-198704000-00017
  37. Littleford JA, Patel MA, Bose D, Cameron CB, McKillop C. Masseter muscle spasm in children: implications of continuing the triggering anesthetic. Anesthesia and Analgesia. 1991;72(2):151-160.  https://doi.org/10.1213/00000539-199102000-00003
  38. O’Flinn RP, Shutack JG, Rosenberg H, Fletcher JE. Masseter muscle rigidity and malignant hyperthermia susceptibility in pediatric patients: An update on management and diagnosis. Anesthesiology. 1994;80(6):1228-1233. https://doi.org/10.1097/00000542-199406000-00009
  39. Schwartz L, Rockoff MA, Koka BV. Masseter spasm with anesthesia: incidence and implications. Anesthesia and Analgesia. 1991;72(6):151-160.  https://doi.org/10.1097/00000542-198412000-00025
  40. Barlow MB, Isaacs H. Malignant hyperpyrexial deaths in a family — Reports of three cases. British Journal of Anaesthesia. 1970;42(12):1072-1076. https://doi.org/10.1093/bja/42.12.1072
  41. Larach MG, Brandom BW, Allen GC, Gronert GA, Lehman EB. Malignant hyperthermia deaths related to inadequate temperature monitoring, 2007-2012: A report from The North American Malignant Hyperthermia Registry of the Malignant Hyperthermia Association of the United States. Anesthesia and Analgesia. 2014;119(6):1359-1366. https://doi.org/10.1213/ANE.0000000000000421
  42. Guze BH, Baxter LR. Neuroleptic malignant syndrome. New England Journal of Medicine. 1985;313(3):163-166.  https://doi.org/10.1056/NEJM198507183130306
  43. Larach MG, Localio AR, Allen GC, Denborough MA, Ellis FR, Gronert GA, Kaplan RF, Muldoon SM, Nelson TE, Ording H, et al. A Clinical Grading Scale to Predict Malignant Hyperthermia Susceptibility. Anesthesilogy. 1994;80(4):771-779.  https://doi.org/10.1097/00000542-199404000-00008
  44. Consensus guidelines on perioperative management of malignant hyperthermia suspected or susceptible patients from the European Malignant Hyperthermia Group. British Journal of Anaesthesia. 2021;126(1):120-130.  https://doi.org/10.1016/j.bja.2020.09.029
  45. Sessler DI. Temperature regulation. In: Gregory GA, ed. Pediatric Anesthesia. 3rd Edition, New York, Churchill Livingstone Inc.; 1994:47-59. 
  46. Hopkins PM, Girard T, Dalay S, Jenkins B, Thacker A, Patteril M, McGrady E. Malignant hyperthermia 2020. Guideline from the Association of Anaesthetists. Anaesthesia. 2021;76(5):655-664.  https://doi.org/10.1111/anae.15317
  47. Hopkins PM, Rüffert H, Snoeck MM, Girard T, Glahn KP, Ellis FR, Müller CR, Urwyler A. The European Malignant Hyperthermia Group. European Malignant Hyperthermia Group guidelines for investigation of malignant hyperthermia susceptibility. British Journal of Anaesthesia. 2015;115(4):531-539.  https://doi.org/10.1093/bja/aev225
  48. Larach MG. Standardization of the caffeine halothane muscle contracture test. For the North American Malignant Hyperthermia Group. Anesthesia and Analgesia. 1989;69(4):511-515. 
  49. Urwyler A, Censier K, Kaufmann MA, Drewe J. Genetic effects on the variability of the caffeine halothane muscle contracture test. Anesthesiology. 1994;80(6):1287-1295. https://doi.org/10.1097/00000542-199406000-00016
  50. Wedel DJ, Nelson TE. Malignant hyperthermia: diagnostic dilemma — false-negative contracture responses with halothane and caffeine alone. Anesthesia and Analgesia. 1994;78(4):787-792.  https://doi.org/10.1213/00000539-199404000-00031
  51. Larach MG, Gronert GA, Allen GC, Brandom BW, Lehman EB. Clinical presentation, treatment, and complications of malignant hyperthermia in North America from 1987 to 2006. Anesthesia and Analgesia. 2010;110(2):498e-07.  https://doi.org/10.1213/ANE.0b013e3181c6b9b2
  52. Wappler F. S1-leitlinie maligne hyperthermie: update 2018. Anaesthesist. 2018;67:529e32.
  53. Lebedinskii KM, Mazurok VA, Karelov AE, et al. Gemodinamicheskie oslozhneniya operatsii i anestezii. In: Krovoobrashchenie i anesteziya. Lebedinskii KM, ed. 2-e izd. SPb: Chelovek; 2015:565-698. (In Russ.).
  54. S1-leitlinie: Therapie der malignen Hyperthermie. Revidierte Version. DGAIinfo; 2018. Accessed July 16, 2023. https://register.awmf.org/assets/guidelines/001-008l_S1_Therapie-maligne-Hyperthermie_2018-03_1.pdf
  55. Riazi S, Kraeva N, Hopkins PM. Updated guide for the management of malignant hyperthermia. Canadian Journal of Anesthesia. 2018;65:709-721.  https://doi.org/10.1007/s12630-018-1108-0
  56. Racca F, Mongini T, Wolfler A, Vianello A, Cutrera R, Del Sorbo L, Capello EC, Gregoretti C, Massa R, De Luca D, Conti G, Tegazzin V, Toscano A, Ranieri VM. Recommendations for anesthesia and perioperative management of patients with neuromuscular disorders. Minerva Anestesiologica. 2013;79(4):419-433. 
  57. Managing a Crisis. American Malignant Hyperthermia Association (MHAUS) Recommendations. Accessed July 16, 2023. https://www.mhaus.org/healthcare-professionals/managing-a-crisis
  58. Reber A, Schumacher P, Urwyler A. Effects of three different types of management on the elimination kinetics of volatile anesthetics. Anaesthesia. 1993;48(10):862-865.  https://doi.org/10.1111/j.1365-2044.1993.tb07414.x
  59. Dynasthetics. Prepare any anesthesia machine for susceptible patients in less than 90 seconds. Accessed July 16, 2023. https://www.dynasthetics.com
  60. Bennett MH, Wainwright AP. Acute thyroid crisis on induction of anaesthesia. Anaesthesia. 1989;44:28-30.  https://doi.org/10.1111/j.1365-2044.1989.tb11093.x
  61. Caroff SN, Roberts CB, Rosenberg H, Tobin JR, Watt S, Mashman D, Riazi S, Berkowitz RM. Intravenous dantrolene in hypermetabolic syndromes: a survey of the U.S. Veterans Health Administration database. BMC Anesthesiology. 2022;22:298.  https://doi.org/10.1186/s12871-022-01841-z
  62. Ryan JF. Malignant hyperthermia: treatment and after care. Anesthesiology Clinics of North America. 1991;4:913-932. 
  63. Young CC, Sladen RN. Hyperthermia. In: Complications in Anesthesia. 2nd edn. Atlee JL, ed. 2007:423-426. 
  64. Pollard BJ. Handbook of Clinical Anaesthesia. Kolotilov LV, Maltsev VV, eds. M.: MEDpress-inform; 2006. (In Russ.).
  65. Litman RS, Smith VI, Larach MG, Mayes L, Shukry M, Theroux MC, Watt S, Wong CA. Consensus statement of the Malignant Hyperthermia Association of the United States on unresolved clinical questions concerning the management of patients with malignant hyperthermia. Anesthesia and Analgesia. 2019;128(4):652-659.  https://doi.org/10.1213/ANE.0000000000004039
  66. Jones PM, Allen BN, Cherry RA, Dubois L, Vogt KN, Shariff SZ, Bray Jenkyn KM, Riazi S, Wijeysundera DN. Association between known or strongly suspected malignant hyperthermia susceptibility and postoperative outcomes: an observational population-based study. Canadian Journal of Anesthesia. 2019;66:161-181.  https://doi.org/10.1007/s12630-018-1250-8
  67. Jones C, Bennett K, Kim TW, Bulger TF, Pollock N. Preparation of Datex-Ohmeda Aestiva and Aisys anaesthetic machines for use in malignant hyperthermia susceptible patients. Anaesthesia and Intensive Care. 2012;40(3):490-497.  https://doi.org/10.1177/0310057X1204000315
  68. Kim TW, Wingate JR, Fernandez AM, Whitaker E, Tham RQ. Washout times of desflurane, sevoflurane and isoflurane from the GE Healthcare Aisys and Avance, Carestation, and Aestiva anesthesia system. Pediatric Anesthesia. 2013;23(12):1124-1130. https://doi.org/10.1111/pan.12234
  69. Kim TW, Nemergut ME. Preparation of modern anesthesia workstations for malignant hyperthermia-susceptible patients: A review of past and present practice. Anesthesiology. 2011;114(1):205-212.  https://doi.org/10.1097/ALN.0b013e3181ee2cb7
  70. Petroz GC, Lerman J. Preparation of the Siemens KION anesthetic machine for patients susceptible to malignant hyperthermia. Anesthesiology. 2002;96(4):941-946.  https://doi.org/10.1097/00000542-200204000-00023
  71. Prinzhausen H, Crawford MW, O’Rourke J, Petroz GC. Preparation of the Dräger Primus anesthetic machine for malignant hyperthermia-susceptible patients. Canadian Journal of Anesthesia. 2006;53(9):885-890.  https://doi.org/10.1007/BF03022831
  72. Beebe JJ, Sessler DI. Preparation of anesthesia machines for patients susceptible to malignant hyperthermia. Anesthesiology. 1988;69(3):395-400.  https://doi.org/10.1097/00000542-198809000-00018
  73. McGraw TT, Keon TP. Malignant hyperthermia and the clean machine. Canadian Journal of Anesthesia. 1989;36(5):530-532.  https://doi.org/10.1007/BF03005381
  74. Schonell LH, Sims C, Bulsara M. Preparing a new generation anaesthetic machine for patients susceptible to malignant hyperthermia. Anaesthesia and Intensive Care. 2003;31(1):58-62.  https://doi.org/10.1177/0310057X0303100112
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