Top Ten Facts You Need to Know About the Perioperative Management of Malignant Hyperthermia

Malignant hyperthermia (MH) is a rare but life-threatening genetic disorder that can be triggered by exposure to volatile anesthetics or succinylcholine. This condition leads to a rapid and uncontrolled hypermetabolic reaction in skeletal muscle, primarily caused by mutations in the ryanodine receptor 1 (RYR1) gene. Early clinical signs include a rapid increase in end-tidal carbon dioxide (EtCO2), tachycardia, and muscle rigidity. As condition progresses, symptoms may escalate to include hyperthermia, rhabdomyolysis, and multi-organ dysfunction. Timely recognition of MH is vital to decrease morbidity and mortality. Management requires the immediate cessation of all triggers, intravenous administration of dantrolene, and supportive care to address associated metabolic abnormalities. While diagnosis is primarily clinical, can be confirmed through contracture testing or genetic analysis. It is also important to consider differential diagnoses such as neuroleptic malignant syndrome, serotonin syndrome, and thyroid storm, especially when typical symptoms or triggers are absent. Preventive strategies, such as using non-triggering total intravenous anesthesia and implementing institutional protocols for MH, are essential for individuals at risk to minimize complications during surgery. Advances in understanding the molecular basis of MH, Malignant Hyperthermia Association of the United States (MHAUS) development of protocols, along with timely access to treatment and thorough perioperative preparation, have significantly decreased the morbidity and mortality associated with this condition.