Malignant hyperthermia is a hypermetabolic crisis in susceptible individuals exposed to triggers (volatile anesthetics or succinylcholine). It occurs in approximately 1 in 100,000 anaesthesias, generally in patients with no history, and more in men than in women (2:1). Pathophysiologically, there is an abnormality of the ryanodine receptors in the striated muscles, which produces an excessive accumulation of calcium in the cytoplasm. The clinical presentation is variable: it generally begins with hypercapnia (92.2%) and sinus tachycardia (72.9%); occasionally rigidity is added (masseter in 26.7% and generalized in 40.8%); continuing with a variable combination of hyperthermia (52.2 to 64.7%) and other manifestations. Management focuses on hyperventilating, suspending triggers, initially administering dantrolene 2.5 mg/kg IV, correcting the internal environment (mainly hyperkalaemia), and cooling the patient externally and internally if necessary. The use of dantrolene should be early; it has a rapid effect monitorable through capnography and heart rate; it must be administered for at least 24 hours; and it has side effects that are usually not serious. Mortality has decreased from 75% in the predantrolene and precapnography era to 6% to 10% today.
Mayanz, S. . (2023). Hipertermia maligna: revisión narrativa con énfasis en cuadro clínico y manejo de la crisis aguda. Boletín De Anestesia, (4), pp. 30–37. Retrieved from https://boletinanestesia.uchile.cl/index.php/BA/article/view/73490
