Malignant hyperthermia: current strategies for effective diagnosis and management

Introduction: Malignant hyperthermia (MH) is a life-threatening, inherited disorder of skeletal muscle calcium metabolism, which is usually triggered by volatile anesthetics and succinylcholine. Mortality of the syndrome has been significantly reduced since introduction of dantrolene. However, dantrolene has relevant pharmacological disadvantages. Diagnosis of MH with in vitro contracture testing are the current standard, but sensitivity as well as specificity of the test procedure are not perfect. Areas covered: This review discusses and summarizes recent advances in management as well as diagnosis of MH. Special focus is directed on a new dantrolene formulation and also on preparation of anesthesia workstations. A literature search was undertaken using several databases including Cochrane, Medline, Pubmed and Science Direct, covering materials up to November 2013. Expert opinion: In this regard, a novel nanocrystalline dantrolene sodium suspension (DSS) was shown to be as effective as the standard dantrolene preparation without relevant side effects. DSS has a much better solubility in water due to the nanoparticle structure and can be dissolved in small volumes of water. This enables a faster administration of dantrolene and consequently hastens treatment of a crisis. Diagnosis of MH may be improved by recent developments in genetic mutation research, especially by characterization of functional effects of specific variants.