Malignant Hyperthermia.

Objectives: A narrative expert review aiming to summarize the clinical epidemiology and management of critically ill patients with malignant hyperthermia (MH).
Data Sources: Medline searches were conducted to identify relevant articles describing the epidemiology, pathophysiology, and management of MH. Guidelines from key MH organizations were also incorporated into this review.
Study Selection: Relevant studies regarding MH in both ICU and perioperative settings were reviewed.
Data Extraction: Data from relevant studies were summarized and qualitatively assessed.
Data Synthesis: MH is a severe reaction triggered by inhalational volatile anesthetics and succinylcholine in genetically susceptible patients. The condition is characterized by an early onset (min to hr) rise in temperature, hypercarbia, and muscular rigidity following exposure to triggering medications with potential complications of coagulopathy, rhabdomyolysis, and acute kidney injury. Acute management necessitates a coordinated multidisciplinary team approach with specific management using dantrolene, active cooling, and hyperventilation. A suspected MH reaction has important implications for future anesthetic exposure for both the patient and their family. All suspected reactions should be followed up at a specialized MH testing center using muscle contracture and genetic testing.
Conclusions: Increasing use of inhalational anesthetics in the ICU underscores the need for enhanced education on the diagnosis and management of MH to ensure optimal patient sedation care and safety.
Competing Interests: Drs. Riazi, Cuthbertson, and Jerath received support for article research from the University of Toronto; they received the Merit Award from the University of Toronto. Dr. Riazi is a board member of the Malignant Hyperthermia Association of the United States (MHAUS) and chair of the Professional Advisory Council (PAC) on Malignant Hyperthermia (MH). Dr. Pinyavat is the Medical Director of the MHAUS MH Hotline and member of the PAC. Drs. Slessarev, Cuthbertson, and Jerath are conducting research on the use of inhalation anesthetics in ICU settings (NCT04415060); they received funding from the Canadian Institutes of Health Research and the Ontario Government. Dr. Jerath disclosed off-label use of inhalational anesthetics. The remaining authors have disclosed that they do not have any potential conflicts of interest.
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