Literature review of clinical signs, diagnostic and treatment options for malignant hyperthermia

Modestas Šaulys1, Paulius Meškauskas1, Valdonė Ališkevičiūtė2

1Lithuanian University of Health Sciences, Academy of Medicine, Kaunas, Lithuania

2Lithuanian University of Health Sciences Kauno klinikos, Department of Anesthesiology, Kaunas, Lithuania


Background. Malignant hyperthermia (MH) is a pharmacogenetic disorder of skeletal muscle that presents as a hypermetabolic response to anesthetic gases and the depolarizing muscle relaxant. According to the literature, there is a tendency for MH to develop dramatically in young patients, often of minor procedures and can be fatal if not treated promptly. Malignant hyperthermia is under constant clinical or biomedical study today, and such analysis and research are undoubtedly relevant to discovering the best diagnostic and treatment options.

Aim. The purpose of this review is to evaluate scientific literature about etiopathogenesis, diagnostic methods and treatment of malignant hyperthermia based on the most relevant medical research.

Materials and methods. A PubMed search was done according to PRISMA guidelines. Following combination of keywords were used: ‘malignant hyperthermia, ‘hypermetabolic syndrome’, ‘complications of anaesthesia‘. The screening process included reading titles and abstracts. The most relevant articles were selected. The majority of the publications analysed were published over past 10 years. Risk of bias was evaluated according to QUADAS – 2 criteria.

Results. Out of the 1239 scientific publications collected with keywords and filters, 97 potentially relevant studies were left after the elimination of duplicates and a brief analysis of titles and abstracts. Full texts were further screened for final inclusion and 25 studies were included in this.

Conclusions. An analysis of the literature suggests that malignant hyperthermia is a rare but fatal disorder. It is important to suspect PH as soon as possible and be prepared to apply treatment protocols. If it is possible to continue analgesia with complete intravenous anesthesia or with a regional analgesic method in the presence of obvious hereditary malignant hyperthermia. Genetic and diagnostic caffeine – halothane test helps prevent PH complications.

Keywords: malignant hyperthermia, hypermetabolic syndrome, complications of anaesthesia.

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