Malignant hyperthermia: A review of the literature

Malignant hyperthermia is a rare pharmacogenetic disorder characterized by hyperpyrexia, muscle rigidity, tachycardia, and respiratory and metablic acidosis. It occurs in response to a variety of inhalational anesthetics and muscle relaxants. Malignant hyperthermia represents an inborn error of skeletal muscle metabolism which renders the muscle susceptible to disturbances of intracellular calcium distribution. It is a catastrophic complication of surgery and carries a 28% mortality rate. Once suspected intraoperatively, all surgery and anesthesia are to be discontinued; the patient must be placed on 100% oxygen, cooled, given sodium bicarbonate and dantrolene, and carefully monitored. Preoperative detection is difficult, but a family history of malignant hyperthermia, abnormalities of back muscles, and elevated CPK are clues. The most accurate diagnostic test is skeletal muscle biopsy. For patients with known malignant hyperthermia, an operation should be performed only if absolutely necessary, and the patient premedicated with dantrolene.