Clinical protocol for the management of malignant hyperthermia

Rev Esp Anestesiol Reanim. 2017 Jan;64(1):32-40. doi: 10.1016/j.redar.2016.06.004. Epub 2016 Sep 12.
[Article in English, Spanish]


Malignant hyperthermia is a hypermetabolic syndrome that appears in susceptible patients after exposure to certain anaesthetic drugs (succinylcholine, inhalation anaesthetics). Its incidence in Spain is 1 in 40,000 adults, with a 10% mortality rate. It is induced by an abnormal regulation of the ryanodine receptors, producing a massive release of calcium from the sarcoplasmic reticulum in the striate muscle. Clinical manifestations include: CO2 increase, tachycardia, haemodynamic instability, metabolic and respiratory acidosis, profuse sweating, hyperpyrexia, CPK increase, myoglobinuria, kidney failure, disseminated intravascular coagulation (DIC), and ending in cardiac arrest. Dantrolene sodium is a ryanodine receptor antagonist, and inhibits the release of intracellular calcium. Definitive diagnosis is achieved by the exposure of muscle fibres to caffeine and halothane. Protocols can help guarantee a reliable and secure management when this severe event occurs.

Keywords: Dantrolene sodium; Dantroleno sódico; Hipertermia maligna; Malignant hyperthermia; Receptor de rianodina; Ryanodine receptor.

Publication types

  • Review

MeSH terms

  • Adolescent
  • Adult
  • Caffeine / pharmacology
  • Calcium Signaling / drug effects
  • Child
  • Child, Preschool
  • Clinical Protocols*
  • Critical Care / methods
  • Dantrolene / pharmacology
  • Dantrolene / therapeutic use
  • Diagnosis, Differential
  • Disease Management*
  • Female
  • Halothane / pharmacology
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Malignant Hyperthermia / diagnosis
  • Malignant Hyperthermia / epidemiology
  • Malignant Hyperthermia / physiopathology
  • Malignant Hyperthermia / therapy*
  • Muscle Contraction / drug effects
  • Muscle Fibers, Skeletal / drug effects
  • Neuroleptic Malignant Syndrome / diagnosis
  • Ryanodine Receptor Calcium Release Channel / drug effects
  • Ryanodine Receptor Calcium Release Channel / physiology
  • Serotonin Syndrome / diagnosis


  • Ryanodine Receptor Calcium Release Channel
  • Caffeine
  • Dantrolene
  • Halothane