Anaesthesia in Malignant Hyperthermia susceptible patients: avoid all volatile anaesthetics

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September 01, 2023

"Because of an increasing awareness of Malignant Hyperthermia (MH) and a more widespread use of the diagnostic in-vitro contracture test, it is not unusual for an anaesthesiologist to be confronted with an MH susceptible patient or a patient who has a family history of MH. The management of such patients should be carefully planned. The provision of safe anaesthesia includes a sufficient preoperative interview and adequate premedication on the one hand and an anaesthesia without triggering agents and suitable monitoring on the other hand," M. Steinfath and F. Wappler emphasize in the textbook "Malignant Hyperthermia".

Malignant Hyperthermia

The key sentences:

Standard premedicant drugs such as benzodiapecines, barbiturates, opioids, and antihistamines do not cause problems in MH susceptible patients when administered in appropriate doses.
Regional anaesthesia using either amide or ester local analgesics can safely be performed.
General anaesthesia performed as total intravenous anaesthesia (TIVA) or balanced anaesthesia including nitrous oxide is safe, provided that care is taken to specially prepare the anaesthesia machine and to avoid anaesthetic trigger agents which are depolarizing muscle relaxants such as succinylcholine and all volatile anaesthetics (Halothane, Enflurane, Isoflurane, Desflurane, Sevoflurane). Dantrolene should be available at any time.
The monitoring should include the standard variables ECG and blood pressure as well as endtidal CO2 and core body temperature. Additional arterial and/or central venous monitoring is recommended for MH susceptible patients, as dictated by the surgical procedure.

Malignant Hyperthermia
Schulte am Esch, J.; Scholz, J.; Wappler, F. (Eds.)
Pabst, 428 Seiten

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