Malignant Hyperthermia: A Pharmacogenetic Disorder

• Published in: Orthopedics (Thorofare, N.J.) Vol. 32; no. 11; pp. 835 - 838
• Main Authors: STRATMAN, Rachel C, FLYNN, Jeremy D, HATTON, Kevin W
• Format: Journal Article
• Language: English
• Published: Thorofare, NJ Slack 01-11-2009; SLACK INCORPORATED
• Subjects: Acidosis; Antipsychotics; Biological and medical sciences; Caffeine; Cardiac arrhythmia; Cyanosis; Dantrolene - therapeutic use; Diseases of the osteoarticular system; Drug dosages; Electrolytes; Fatalities; Fever; Genetic Predisposition to Disease; Genetic testing; Humans; Hyperkalemia; Hyperthermia; Hypocalcemia; Lifesaving; Malignant Hyperthermia - genetics; Malignant Hyperthermia - physiopathology; Malignant Hyperthermia - therapy; Medical sciences; Metabolism; Muscle contraction; Muscle Relaxants, Central - therapeutic use; Musculoskeletal system; Mutation; Narcotics; Pulmonary arteries; Rhabdomyolysis; Ryanodine Receptor Calcium Release Channel - genetics; Syndrome; Pharmacogenetics; Treatment; Orthopedics; Genetics; Malignant tumor; Induced hyperthermia; Cancer
• ISSN: 0147-7447; 1938-2367
• DOI: 10.3928/01477447-20090922-18

[...]patients commonly develop myoglobinemia, myoglobinuria, hyperkalemia, hyperphosphatemia, and hypocalcemia. Other disorders that resemble malignant hyperthermia include thyroid storm, pheochromocytoma, heat stroke, and cocaine/ecstasy overdose.4,15 Treatment Treatment of malignant hyperthermia requires the rapid identification of symptoms, discontinuation of the triggering agent, institution of dantrolene therapy, and control of associated symptoms. Nitrous oxide Propofol Benzodiazepines Midazolam Lorazepam Diazepam Etomidate Barbiturates Thiopental Opioids Fentanyl Morphine Ketamine Non-depolarizing neuromuscular blockers Atracurium Cisatracurium Vecuronium Rocuronium Pancuronium Mivacurium Doxacurium Pipecuronium Local anesthetics Lidocaine Bupivacaine Tetracaine Vasopressors Norepinephrine Epinephrine Vasopressin Dopamine Inotropes Dobutamine Table 2 Safe Agents for Susceptible Malignant Hyperthermia Patients Dantrolene therapy, a skeletal muscle relaxant that inhibits the excitation-contraction coupling in skeletal muscle without affecting neuromuscular transmission or the electrical properties of the muscle, should also be initiated as rapidly as possible to prevent the development of the rapidly deteriorating clinical course described above.4,16,17 Dantrolene preparation should begin as soon as possible as it entails a time-consuming reconstitution process and requires several people for its rapid preparation. Core temperature must be monitored using appropriate monitoring sites including the pulmonary artery, distal esophagus, nasopharynx, tympanic membrane, rectum, bladder, or axilla.