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Malignant hyperthermia

Key sources
The following summarized guidelines for the evaluation and management of malignant hyperthermia are prepared by our editorial team based on guidelines from the Association of Anaesthetists (AA 2021) and the European Malignant Hyperthermia Group (EMHG 2021; 2010).
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Guidelines

1.Screening and diagnosis

Diagnosis: suspect MH in case of an unexplained and unexpected progressive increase in CO2 production as evidenced in ETCO2.
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2.Respiratory support

Hyperventilation therapy
Initiate hyperventilation (use a minute volume 2-3 times normal) with 100% oxygen at high flow immediately in patients with MH crisis.
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Initiate hyperventilation to normocapnia in patients with acidosis.
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3.Medical management

General principles
As per AA 2021 guidelines:
Aim the management of an MH reaction toward immediately reversing the reaction and treating the consequences of the reaction.
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Refer patients with suspected MH reaction to a tertiary assessment unit for MH.
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  • Prevention of kidney injury

4.Inpatient care

Monitoring during acute crisis: monitor the following during acute crisis of MH:
routine anesthetic parameters (ECG, noninvasive arterial pressure, SaO2, ETCO2)
core temperature
blood potassium, CK, arterial blood gases, myoglobin, and glucose
renal and hepatic function
coagulation
signs of compartment syndrome
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5.Nonpharmacologic interventions

Body cooling: as per AA 2021 guidelines, initiate active body cooling in patients with MH.
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6.Perioperative care

Perioperative assessment: as per AA 2021 guidelines, elicit a personal and family history of anesthetic problems as part of the preoperative assessment in all patients requiring general or regional anesthesia.
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7.Patient education

General counseling: inform the patient and their primary care physician before discharge from the hospital about the suspected diagnosis of MH and its implications.
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8.Preventative measures

Avoidance of triggers
As per AA 2021 guidelines:
Ensure the availability of activated charcoal filters at all locations where general anesthesia is administered.
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Do not expose patients at increased risk of developing MH to potent inhalation anesthetics or suxamethonium.
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