Updated guide for the management of malignant hyperthermia

Can J Anaesth. 2018 Jun;65(6):709-721. doi: 10.1007/s12630-018-1108-0. Epub 2018 Mar 29.


Purpose: This continuing professional development module aims to prepare anesthesiologists for the timely recognition and management of a malignant hyperthermia (MH) reaction, which is crucial for averting its life-threatening complications and ultimately for the patient's survival.

Principal findings: Malignant hyperthermia is a genetic disorder of skeletal muscle cells affecting myoplasmic calcium homeostasis. It can present with nonspecific signs of a hypermetabolic reaction, which can be fatal if treatment, including administration of dantrolene sodium, is not implemented promptly. Rapid evaluation and rejection of alternative diagnoses can lead to a prompt diagnosis and treatment and therefore will significantly reduce the complications, including renal failure, cardiac dysfunction, disseminated intravascular coagulation, and death. After the reaction, patients should be observed for a minimum of 24 hr because of the possibility of recrudescence. As it is a genetic condition, survivors and their family members should be referred to a specialized MH centre for further testing and counselling.

Conclusions: The risk of dying from MH has increased over the past few years. A knowledgeable anesthesiologist who is diligent and attentive can recognize signs of an impending MH reaction and treat promptly to avoid complications of this deadly condition.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Adolescent
  • Appendectomy
  • Female
  • Guidelines as Topic
  • Humans
  • Malignant Hyperthermia / epidemiology
  • Malignant Hyperthermia / genetics
  • Malignant Hyperthermia / therapy*