Evaluation of suspected malignant hyperthermia events during anesthesia

Schuster, Frank; Johannsen, Stephan; Schneiderbanger, Daniel; Roewer, Norbert

doi:10.1186/1471-2253-13-24

Cited by 21 publications

(16 citation statements)

References 35 publications

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“…The literature reported 21 MH events after the administration of succinylcholine without exposure to volatile anesthetic agents, 18 in the United States or Canada. 27,[59][60][61][62][63] These cases did not overlap with the two North American Malignant Hyperthermia Registry events. Succinylcholine doses were 0.5 to 2.5 mg/kg (n = 12).…”

Section: Does Administration Of Succinylcholine Without Concomitant Vmentioning

confidence: 99%

Succinylcholine Use and Dantrolene Availability for Malignant Hyperthermia Treatment

Larach¹,

Klumpner

Brandom

et al. 2019

Anesthesiology

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EDITOR’S PERSPECTIVE What We Already Know about This Topic Dantrolene effectively treats malignant hyperthermia, but there are discrepant recommendations for dantrolene availability in facilities that stock succinylcholine for airway rescue but do not use volatile anesthetics. What This Article Tells Us That Is New The authors performed an analysis of data from three databases and a systematic literature review. Providers frequently use succinylcholine, including during difficult mask ventilation. Succinylcholine given without volatile anesthetics triggered 24 malignant hyperthermia events, 13 of which were treated with dantrolene. Fourteen patients experienced substantial complications, and one died. Delayed dantrolene treatment worsened patient outcomes. Background Although dantrolene effectively treats malignant hyperthermia (MH), discrepant recommendations exist concerning dantrolene availability. Whereas Malignant Hyperthermia Association of the United States guidelines state dantrolene must be available within 10 min of the decision to treat MH wherever volatile anesthetics or succinylcholine are administered, a Society for Ambulatory Anesthesia protocol permits Class B ambulatory facilities to stock succinylcholine for airway rescue without dantrolene. The authors investigated (1) succinylcholine use rates, including for airway rescue, in anesthetizing/sedating locations; (2) whether succinylcholine without volatile anesthetics triggers MH warranting dantrolene; and (3) the relationship between dantrolene administration and MH morbidity/mortality. Methods The authors performed focused analyses of the Multicenter Perioperative Outcomes Group (2005 through 2016), North American MH Registry (2013 through 2016), and Anesthesia Closed Claims Project (1970 through 2014) databases, as well as a systematic literature review (1987 through 2017). The authors used difficult mask ventilation (grades III and IV) as a surrogate for airway rescue. MH experts judged dantrolene treatment. For MH morbidity/mortality analyses, the authors included U.S. and Canadian cases that were fulminant or scored 20 or higher on the clinical grading scale and in which volatile anesthetics or succinylcholine were given. Results Among 6,368,356 queried outcomes cases, 246,904 (3.9%) received succinylcholine without volatile agents. Succinylcholine was used in 46% (n = 710) of grade IV mask ventilation cases (median dose, 100 mg, 1.2 mg/kg). Succinylcholine without volatile anesthetics triggered 24 MH cases, 13 requiring dantrolene. Among 310 anesthetic-triggered MH cases, morbidity was 20 to 37%. Treatment delay increased complications every 10 min, reaching 100% with a 50-min delay. Overall mortality was 1 to 10%; 15 U.S. patients died, including 4 after anesthetics in freestanding facilities. Conclusions Providers use succinylcholine commonly, including during difficult mask ventilation. Succinylcholine administered without volatile anesthetics may trigger MH events requiring dantrolene. Delayed dantrolene treatment increases the likelihood of MH complications. The data reported herein support stocking dantrolene wherever succinylcholine or volatile anesthetics may be used.

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Section: Does Administration Of Succinylcholine Without Concomitant Vmentioning

confidence: 99%

Succinylcholine Use and Dantrolene Availability for Malignant Hyperthermia Treatment

Larach¹,

Klumpner

Brandom

et al. 2019

Anesthesiology

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“…However, these tests are usually available at specialized centers only. Minimally invasive, intramuscular halothane and caffeine test also has been described recently (122)…”

Section: Myopathies Associated With Anesthetic Agents and Centrally Amentioning

confidence: 99%

Toxic Myopathies

2014

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Muscle tissue is highly sensitive to many substances. Early recognition of toxic myopathies is important, as they potentially are reversible on removal of the offending drug or toxin, with greater likelihood of complete resolution the sooner this is achieved. Clinical features range from mild muscle pain and cramps to severe weakness with rhabdomyolysis, renal failure, and even death. The pathogenic bases can be multifactorial. This article reviews some of the common toxic myopathies and their clinical presentation, histopathologic features and possible underlying cellular mechanisms.

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“…Therefore, in this study the 44.2% of patients with a 'less than likely' or 'unlikely' clinical grading scale score are attributed to limitations in data collection rather than incomplete phenotypic presentation. On the other hand, one recent article by Schuster et al does address the difficulty in diagnosing abortive courses 5 .…”

Section: Discussionmentioning

confidence: 99%

The Changing Face of Malignant Hyperthermia: Less Fulminant, More Insidious

Heytens

Forget

Scholtès

et al. 2015

Anaesth Intensive Care

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Modern anaesthetic techniques have resulted in the clinical presentation of malignant hyperthermia to be more often indolent and/or insidious than truly fulminant, as previously known in the anaesthetic community. We present four recently referred cases to illustrate this point: one late-onset case, two patients with slowly progressive hypercapnia as the sole sign and a fourth patient with postoperative myalgias and elevated creatine kinase. We also discuss the reasons for the shift in typical clinical presentation. The more insidious character of malignant hyperthermia is most likely due to the lower triggering potency of modern volatile anaesthetics, the mitigating effects of several intravenous drugs (neuromuscular blocking agents, alpha 2 adrenergic receptor agonists, beta-adrenergic blockade) or techniques (neuraxial anaesthesia) and the routine use of end-tidal CO 2 monitoring leading to the early withdrawal of triggering drugs. Awareness among anaesthetists of this change in presentation is important since the clinical diagnosis is often more doubtful and, if corroborative evidence is not sought, the diagnosis may be delayed or missed altogether.

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Evaluation of suspected malignant hyperthermia events during anesthesia

Cited by 21 publications

References 35 publications

Succinylcholine Use and Dantrolene Availability for Malignant Hyperthermia Treatment

Succinylcholine Use and Dantrolene Availability for Malignant Hyperthermia Treatment

Toxic Myopathies

The Changing Face of Malignant Hyperthermia: Less Fulminant, More Insidious

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