Malignant Hyperthermia: A Review

Malignant hyperthermia (MH) is a complex pharmacogenetic condition associated with the development of a hypermetabolic state when exposed to specific "triggering" anesthetic medications.These inciting agents include all potent inhalational anesthetics (e.g., halothane, sevoflurane, desflurane, isoflurane) and succinylcholine.While poorly understood, mutations in the ryanodine receptor are thought to play a pathogenic role in this genetic condition: these mutations are typically inherited in an autosomal dominant fashion or may be de novo mutations.The mainstay of treatment for patients with a history or family history of MH is avoidance of these triggering anesthetic agents.If a crisis occurs, discontinuation of the offending agent, prompt expert consultation, and targeted therapy with dantrolene have decreased the mortality of this condition from >70 to <10%.Future directions for MH research include more accurate genetic testing, a better understanding of the disease mechanism, and continued research for the optimal management of MH crises.