Anesthesia for patients with a history of malignant hyperthermia

Malignant hyperthermia-susceptible patients have an increased risk during anaesthesia. The aim of this review is to present current knowledge about pathophysiology and triggers of malignant hyperthermia as well as concepts for safe anaesthesiological management of these patients.

Trigger substances and mechanisms have been well defined to date. Anaesthesia can be safely performed with i.v. anaesthetics, nitrous oxide, nondepolarizing muscle relaxants, local anaesthetics as well as xenon. Attention must be directed to the preparation of the anaesthetic machine because modern workstations need longer cleansing times than their predecessors. Alternatively, activated charcoal might be beneficial for elimination of volatile anaesthetics. Day case surgery can be performed in malignant hyperthermia-susceptible patients, if all safety aspects are regarded. Whether there is an association between malignant hyperthermia susceptibility and other disorders is still a matter of debate.

The incidence of malignant hyperthermia is low, but the prevalence can be estimated as up to 1: 3000. Because malignant hyperthermia is potentially lethal, it is relevant to establish management concepts for perioperative care in susceptible patients. This includes preoperative genetic and in-vitro contracture testing, preparation of the anaesthetic workstation, use of nontriggering anaesthetics, adequate monitoring, availability of sufficient quantities of dantrolene and appropriate postoperative care. Taking these items into account, anaesthesia can be safely performed in susceptible patients.