Which drugs cause malignant hyperthermia

Compr Ther. Clinical presentation, treatment, and complications of malignant hyperthermia in North America from to Anesth Analg. Orphanet J Rare Dis. Accessed October 19, Safe and unsafe anesthetics. Hopkins PM. Malignant hyperthermia: pharmacology of triggering. Br J Anaesth. Malignant hyperthermia in Canada: characteristics of index anesthetics in malignant hyperthermia susceptible probands.

Case report: death in the emergency department: an unrecognized awake malignant hyperthermia-like reaction in a six-year-old. Identical de novo mutation in the type 1 ryanodine receptor gene associated with fatal, stress-induced malignant hyperthermia in two unrelated families. Nelson P, Litman RS. Malignant hyperthermia in children: an analysis of the North American Malignant Hyperthermia Registry. Managing a crisis.

Accessed October 25, Revonto dantrolene package insert. Ryanodex dantrolene package insert. Dantrium dantrolene package insert. Traynor K. Readiness for malignant hyperthermia can be survey stumbling block. Am J Health Syst Pharm. How to be prepared. Featured Issue Featured Supplements. The mechanism may involve anesthetic-induced potentiation of calcium Ca exit from the sarcoplasmic reticulum of skeletal muscle in susceptible patients.

As a result, Ca-induced biochemical reactions are accelerated, causing severe muscle contractions and elevation of the metabolic rate, resulting in respiratory and metabolic acidosis. In response to the acidosis, patients breathing spontaneously develop tachypnea that only partially compensates. There are During the process, increased platelet aggregation and coagulation In older patients and patients with comorbidities, DIC may increase the risk of death.

Malignant hyperthermia may develop during anesthesia or the early postoperative period. Muscular rigidity, especially in the jaw, is often the first sign, followed by tachycardia, other arrhythmias, tachypnea, acidosis, shock, and hyperthermia. Hypercapnia detected by increased end-tidal carbon dioxide [CO2] may be an early sign.

Urine may appear brown or bloody if rhabdomyolysis and myoglobinuria have occurred. The diagnosis is suspected by the appearance of typical symptoms and signs within 10 minutes to, occasionally, several hours after inhalational anesthesia is begun 1 Key Points Malignant hyperthermia is a life-threatening elevation in body temperature usually resulting from a hypermetabolic response to concurrent use of a depolarizing muscle relaxant and a potent, Early diagnosis can be facilitated by prompt recognition of jaw rigidity, tachypnea, tachycardia, and increased end-tidal CO2.

There are no immediately confirmatory tests, but patients should have testing for complications, including electrocardiogram, blood tests complete blood count with platelets, electrolytes, blood urea nitrogen, creatinine, creatine kinase, calcium, prothrombin time, partial thromboplastin time, fibrinogen, D-dimer , and urine testing for myoglobinuria. Other diagnoses must be excluded. Perioperative sepsis may cause hyperthermia but rarely as soon after anesthetic induction. Inadequate anesthesia can cause increased muscle tone and tachycardia but not elevated temperature.

Thyroid storm and pheochromocytoma rarely manifest immediately after anesthetic induction. Testing for susceptibility to malignant hyperthermia is recommended for people at risk based on a family history of the disorder or a personal history of a severe or incompletely characterized previous adverse reaction to general anesthesia.

Over the past 50 yr, many drugs have been implicated as triggers of malignant hyperthermia MH , a potentially fatal pharmacogenetic disorder of skeletal muscle calcium regulation. This review discusses the potent inhalation agents as the principal triggers and evidence that the modern agents, desflurane, sevoflurane, and isoflurane, can cause florid MH reactions in the same way as halothane but also are associated with reactions whose onset is delayed for several hours into anaesthesia.

The abnormal gene is most commonly inherited, usually from one parent who also has it. Less often, the abnormal gene is not inherited and is the result of a random gene mutation. Different genes can cause the disorder. The most commonly affected gene is RYR1. If you have a family history of malignant hyperthermia or a relative who has problems with anesthesia, tell your doctor or anesthesiologist before surgery or any procedure that requires anesthesia.

Evaluating your risk of malignant hyperthermia allows your anesthesiologist to avoid certain anesthesia drugs. Mayo Clinic does not endorse companies or products. Advertising revenue supports our not-for-profit mission.

This content does not have an English version. This content does not have an Arabic version. Overview Malignant hyperthermia is a severe reaction to certain drugs used for anesthesia. Request an Appointment at Mayo Clinic. Share on: Facebook Twitter.