Information on therapies for malignant hyperthermia
In the rare and potentially life-threatening condition known as Malignant Hyperthermia (MH), immediate action is crucial. The recommended treatment is the administration of Dantrolene, a direct-acting muscle relaxant, given intravenously.
Dantrolene, a cornerstone intervention, offers lifesaving efficacy when given promptly. It works by reducing heat production in muscles and relieving rigidity, addressing the muscle hypermetabolism characteristic of MH. The recommended starting dose is 2.5 mg/kg, repeated every 5 minutes as needed until symptoms improve [1][4].
While Dantrolene is effective, it does come with manageable side effects. Primarily, these relate to its muscle-relaxing properties and can include muscle weakness, liver toxicity with prolonged or high-dose use, phlebitis at the intravenous injection site, and possible dizziness, fatigue, or gastrointestinal symptoms [1].
Given these risks, Dantrolene should be administered strictly when MH is diagnosed or strongly suspected, and patients should be monitored for side effects during and after treatment [1].
For individuals with a family history of MH, alternative anesthetic agents such as diazepam, ketamine, nitrous oxide, and fentanyl are recommended [5]. All facilities administering agents that could trigger MH should always have Dantrolene on hand [6].
If a person develops symptoms of MH while under anesthesia, the doctor will try to end the surgery and discontinue the triggering agent. Oxygen therapy, IV fluids, and cooling techniques may also be used to manage symptoms and stabilise the patient [2][3].
The Malignant Hyperthermia Association of the United States (MHAUS) advises that healthcare professionals in the United States call their malignant hyperthermia hotline at 800-644-9737, and those outside the United States can call 001-209-417-3722 for advice and support [7].
MH affects all ethnic groups, with a mean age of 21-23 years, and is a rare hereditary condition that affects 1 in 100,000 adults and 1 in 30,000 children [8]. With quick and effective treatment, people experiencing MH may have a favourable outlook.
References:
[1] Malignant Hyperthermia Association of the United States. (2021). Malignant Hyperthermia Treatment. Retrieved from https://mhaus.org/patients-and-families/mh-treatment/
[2] National Organization for Rare Disorders. (2021). Malignant Hyperthermia. Retrieved from https://rarediseases.org/diseases/malignant-hyperthermia/
[3] UpToDate. (2021). Malignant hyperthermia: Clinical manifestations and diagnosis. Retrieved from https://www.uptodate.com/contents/malignant-hyperthermia-clinical-manifestations-and-diagnosis
[4] UpToDate. (2021). Malignant hyperthermia: Treatment. Retrieved from https://www.uptodate.com/contents/malignant-hyperthermia-treatment
[5] Malignant Hyperthermia Association of the United States. (2021). Anesthetic Management for MH Susceptible Individuals. Retrieved from https://mhaus.org/patients-and-families/anesthetic-management-for-mh-susceptible-individuals/
[6] Malignant Hyperthermia Association of the United States. (2021). MH Emergency Preparedness. Retrieved from https://mhaus.org/patients-and-families/mh-emergency-preparedness/
[7] Malignant Hyperthermia Association of the United States. (2021). MH Hotline. Retrieved from https://mhaus.org/patients-and-families/mh-hotline/
[8] National Organization for Rare Disorders. (2021). Malignant Hyperthermia Fact Sheet. Retrieved from https://rarediseases.org/sites/default/files/2019-08/malignant-hyperthermia-fact-sheet.pdf
- In cases of health-and-wellness emergency such as MH, swift action involves administering Dantrolene, a direct-acting muscle relaxant crucial for general health, as it targets the muscle hypermetabolism characteristic of MH, reducing heat production and relieving rigidity.
- The pharmacy sector plays a crucial role in ensuring that facilities have Dantrolene readily available, as this life-saving drug is vital for managing MH, a rare, potentially life-threatening condition.
- MH is a hereditary condition that impacts mental-health and overall wellness, with approximately 1 in 100,000 adults and 1 in 30,000 children affected, affecting all ethnic groups and typically surfacing at a mean age of 21-23 years.
- For those with a family history of MH, therapies-and-treatments that involve alternative anesthetic agents, such as diazepam, ketamine, nitrous oxide, and fentanyl, are recommended to minimize the risk of experiencing MH during medical procedures.
