Malignant hyperthermia susceptibility--successful management with a "stressfree" technique

The pathogenesis of the malignant hyperthermia syndrome is not yet completely understood. There is evidence of involvement of the sympathoadrenergic system. We describe the anesthetic management of two patients considered to be MH-susceptible. Management in the theater included an infusion of dantrolene 2.5 mg/kg prior to induction of anesthesia. In addition, the first patient was given a peroral prophylaxis with dantrolene; in subsequent cases this route of administration was abandoned. Anesthesia was performed with a drug combination devoid of sympathomimetic effects (diazepam, flunitrazepam, midazolam,--methohexital,--fentanyl, alfentanil,--vecuronium). Monitoring should include ECG, blood pressure, body temperature and end-tidal CO2-concentration.