The Journal of the Arkansas Medical Society Med Journal Aug 2019 Final 2 | Page 19
atile anesthetics, it is important to always keep
in mind the diagnosis and a promptness to treat.
This case is exemplary of a situation where suc-
cinylcholine is administered to facilitate endo-
tracheal intubation without exposing the patient
to anesthetic gases. Recognition of this clinical
syndrome cannot be undermined.
In addition, prior exposure to an offending
agent without signs or symptoms of malignant
hyperthermia does not rule out the diagnosis.
Furthermore, when a patient presents with the
above signs and symptoms, it is important to
recognize them and treat early. There are not
many side effects to treating MH with dan-
trolene; whereas, the end result of not treating
MH promptly is death. Early recognition and
treatment of MH is critical to patient survival and
is a necessary skill for first responders, emer-
gency personnel, and trauma staff. While more
studies are needed to elucidate the actual mag-
nitude risk of MH associated with succinylcho-
line administration alone, it is becoming clear
that organizations where succinylcholine may
be used with or without triggering inhalational
agents should have both the MH antidote (dan-
trolene) and a clearly outlined approach for the
management of an MH crisis readily available in
case an event occurs.
Once the diagnosis of MH is made, the timely
response to treatment is potentially life-saving.
Emergency treatment of MH consists of dis-
continuation of volatile agents and succinylcho-
line. The crash cart and dantrolene should be at
bedside. Hyperventilation with 100% oxygen at
flows of greater than 10L/min should be aimed at
achieving lower levels of EtCO 2. Simultaneously,
dantrolene should be given at a bolus dose of 2.5
mg/kg through a large-bore intravenous access.
Cumulative doses of greater than 10 mL/kg may
be given until the symptoms of contracture or ri-
gidity resolve. Blood gases may be measured to
guide therapy and monitor the degree of metabol-
ic acidosis and hyperkalemia. The patient’s core
temperature should be cooled if rapidly rising
>39°C. The Malignant Hyperthermia Association
of the United States (MHAUS) should be contacted
for incidence report and further guidance of this
life-threatening disorder.
Background
1. Iaizzo PA, Wedel DJ. Response to succinyl-
choline in porcine malignant hyperther-
mia. Anesth Analg 1994;79:143-51.
2. Hopkins PM. Malignant hyperthermia:
pharmacology of triggering. Br J An-
aesth 2011;107:48-56.
3. Almeida da Silva HC, dos Santos Almeida C,
Mendes Brandão JC, et al. Malignant hyper-
thermia in Brazil: analysis of hotline activity
in 2009. Rev Bras Anestesiol 2013;63:13-9.
4. Riazi S, Larach MG, Hu C, et al. Malignant
hyperthermia in Canada: characteristics
of index anesthetics in 129 malignant hy-
perthermia susceptible probands. Anesth
Analg 2014;118:381-7.
5. Visoiu M, Young MC, Wieland K, et al. Anes-
thetic drugs and onset of malignant hyper-
thermia. Anesth Analg 2014;118:388-96.
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