Malignant hyperthermia syndrome

M, metaboiism S, at or near site of action IV, intravenously MHS, malignant hyperthermia syndrome ALA, aianine ICU, intensive care unit CNS, central nervous system MAOI, monoamine oxidase inhibitor, NSAID, non-steroidal anti-inflammatory drug ACE, angiotensin in-converting enzyme 5-HT, 5-hydrox ryptamine. 

Anaesthesia in MH-susceptible patients is achieved safely with total intravenous anaesthesia using propofol and opioids. Dantrolene for intravenous use must be available in every surgical theatre. The relation of malignant hyperthermia syndrome with neuroleptic malignant syndrome (for which dantrolene may be used as adjunctive treatment, see p. 388) is uncertain. 

Malignant hyperthermia also occurs in swine. Susceptible animals homozygous for malignant hyperthermia respond to stress with a fatal reaction (porcine stress syndrome) similar to that exhibited by humans. If the reaction occurs prior to slaughter, it affects the quality of the pork adversely, resulting in an inferior product. Both events can result in considerable economic losses for the swine industry. 

Andreoli TE Ion transport disorders introductory comments. Am J Med 1998 104 85. (First of a series of articles on ion transport disorders published between January and August, 1998. Topics covered were structure and function of ion channels, arrhythmias and antiarrhythmic drugs, Liddle syndrome, cholera, malignant hyperthermia, cystic fibrosis, the periodic paralyses and Bartter syndrome, and Gittelman syndrome.)... 

The answer is d. (Hardman, p 188J Malignant hyperthermia (hyperpyrexia), a syndrome that is associated with the use of a general... 

An area where 31P NMR spectroscopy has been widely used is in the studies on the phenomenon of malignant hyperthermia. The syndrome is initiated by halothane and therefore also referred to as halothane susceptibility, and the gene associated with the defect is named the halothane... 

Chronic use of neuroleptics can, on occasion, give rise to hepatic damage associated with cholestasis. A very rare, but dramatic, adverse effect is the malignant neuroleptic syndrome (skeletal muscle rigidity, hyperthermia, stupor) that can end fatally in the absence of intensive countermeasures (including treatment with dantrolene, p. 182). 

Intrathecal - Early symptoms of baclofen withdrawal may include return of baseline spasticity, pruritus, hypotension, and paresthesias. Some clinical characteristics of the advanced intrathecal baclofen withdrawal syndrome may resemble autonomic dysreflexia, infection (sepsis), malignant hyperthermia, neuroleptic-malignant syndrome, or other conditions associated with a hypermetabolic state or widespread rhabdomyolysis. 

Keck PE Jr, Caroff SN, McElroy SL (1995) Neuroleptic malignant syndrome and malignant hyperthermia end of a controversy J Neuropsychiatry Clin Neurosci 7(2) 135-144... 

Ward A, Chaffman MO, Sorkin EM. Dantrolene. A review of its pharmacodynamic and pharmacokinetic properties and therapeutic use in malignant hyperthermia, the neuroleptic mahgnant syndrome and an update of its use in muscle spasticity. Drugs 1986 32(2) 130-68. 

Malignant hyperthermia, possibly triggered by pancuronium, has been described (25), although pancuronium is generally considered to be safe in patients who are susceptible to the syndrome (26). 

Anaphylactoid reactions have been documented, and signs suggestive of histamine release are not uncommon. These are mostly mild such as flushing of the skin. Occasionally bronchospasm and/or hypotension can lead to circulatory arrest. Suxamethonium is the relaxant most commonly associated with the syndrome of malignant hyperthermia. 

There is an association between (latent) muscular dystrophy (usually of the Duchenne or Becker type) and the production of rhabdomyolysis by suxamethonium (84,85,89,90). Suxamethonium can cause excessive muscle damage in these patients, as manifested not only by severe myoglobinemia and raised serum creatine kinase activity but also by acute exacerbation of muscle weakness postoperatively (SEDA-11, 121) (7,29,84,91,92). Massive potassium release can result in hyperkalemic cardiac arrest. Such patients may also develop features suggestive of the syndrome of malignant hyperthermia (93,94). Suxamethonium should not be used in patients with Duchenne muscular dystrophy or who have a family history suspect for the condition. 

Management of fulminant hypermetabolism of skeletal muscle because of malignant hyperthermia crisis. Treatment of neuroleptic malignant syndrome, relief induced pain in patients with muscular of exercise-dystrophy, treatment of flexor spasms... 

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