A survey for prevention and treatment of malignant hyperthermia in Taiwan

Malignant hyperthermia (MH) is a hypermetabolic disorder with high mortality. Intravenous administration of dantrolene is the specific treatment. However, the only means to lower mortality rate are early detection and suitable treatment. Therefore, properly monitoring and handy availability of dantrolene are essential to lower the mortality of MH. This study was designed to evaluate the capabilities in prevention and treatment of MH of the hospitals in Taiwan.

There were 102 certified training hospitals (including medical centers and regional hospitals) in Taiwan selected for this study. A questionnaire was designed to evaluate the capabilities of these hospitals in dealing with prevention and treatment of MH.

A total of 66 copies of the questionnaire were returned, which gave a response rate of 64.7%. The results of the survey are as follows: Succinylcholine was frequently used for induction in 92% of the hospitals investigated. For monitoring during general anesthesia, pulse oximeter was routinely used in 66(100%) hospitals, and ETCO2 monitor in 51 (77.3%) hospitals but continuous body temperature was routinely monitored only in 13 (19.7%) hospitals. Six or more vials of dantrolene were stored and available for immediate use in 23 (34.9%) hospitals and the rest of 43 (65.1%) hospitals did not have any stock of dantrolene at all. Of these 43 hospitals, 25 (58.1%) relied on other hospitals to supply dantrolene and the time required to obtain dantrolene from other hospitals was 70.7 +/- 34.7 min. There were 21 cases who sustained MH in 17 (25.8%) hospitals in the past ten years, of whom 15 were resuscitated successfully and 6 died, thus giving a mortality rate of 28.6%.

This study has revealed that in some hospitals in Taiwan intraoperatively (anesthetic) monitoring is inadequate and there is no stockpile of dantrolene for immediate treatment of MH. We recommend that appropriate anesthetic monitoring equipment should be strictly applied and a stock of initial dose of dantrolene (6 vials) should be kept, which are necessary for early diagnosis and treatment of MH.