Management of malignant hyperthermia

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 May;76(5):655-664. Free full-text.


Kim KSM, Kriss RS, Tautz TJ. Malignant Hyperthermia: A Clinical Review. Adv Anesth. 2019 Dec;37:35-51. Full-text for Emory users.


Hopkins PM. Malignant hyperthermia: pharmacology of triggering. Br J Anaesth. 2011 Jul;107(1):48-56.

Other drugs implicated as triggers of MH:

  • Serotonergic drugs
  • Phosphodiesterase type III inhibitors
  • Statins
  • Tetracaine
  • Methylene blue
  • Ondansteron

Liu PT. Anesthesia. In: Dangleben DA, Madbak FG. eds. ABSITE Slayer, 2e. McGraw-Hill; Accessed April 30, 2021. 

Triggering agents for malignant hyperthermia:
Volatile anesthetics (halothane, enflurane, isoflurane, sevoflurane, desflurane) and depolarizing paralytic succinylcholine

What mechanism leads to malignant hyperthermia?
Mutation of the ryanodine receptors located on the sarcoplasmic reticulum, resulting in a drastic increase in intracellular calcium levels and inducing an uncontrolled increase in skeletal muscle oxidative metabolism

First sign seen with malignant hyperthermia? Other signs?
Increase in end-tidal CO2. Acidosis, fever, hyperkalemia, rigidity, tachycardia.


More PubMed results on MH.

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