Malignant hyperthermia during general anesthesia: medicolegal considerations

Malignant hyperthermia is a pathophysiologic process, the occurrence of which is nearly impossible to predict, the diagnosis difficult to discover rapidly, and the treatment unsuccessful in the majority of cases as is borne by the high mortality rate. It is in almost all instances, a fortuitous event, and liability will most probably not be imposed unless the plaintiff can establish by way of expert testimony that defendant-anesthesiologist departed from acceptable methods of care. Definite departures from the present standard of care could be: (1) administering a potent general anesthetic utilizing halogenated inhalation agents and depolarizing muscle relaxants to an individual who has undergone a previous malignant hyperthermia episode, and possibly to a member of his immediate family; (2) failing to have available appropriate resuscitative equipment; and of course, (3) lack of diligence and due care in attempting to treat a case of malignant hyperthermia. It seems, at this point, that serum CPK levels and constant temperature monitoring are additional safeguards, but are not part of the standard of care imposed upon the anesthesiologist.