THERAPEUTIC MANAGEMENT OFMALIGNANT HYPERTHERMIA: A COMPREHENSIVE REVIEW

Satish S., Sandra Thattiott* and A. R. Shabaraya

ABSTRACT

Background: Malignant hyperthermia (MH) is a rare, life-threatening pharmacogenetic disorder typically triggered by certain anesthetic agents and muscle relaxants. It is characterized by rapid onset of hypermetabolic crisis, leading to severe hyperthermia, acidosis, muscle rigidity, and rhabdomyolysis. Prompt recognition and treatment are crucial to reduce morbidity and mortality. Objective: This review aims to provide a comprehensive overview of the therapeutic management of MH, including the pathophysiology, early recognition, and latest advancements in treatment protocols. Methods: A thorough literature search was conducted using databases such as PubMed, MEDLINE, and Cochrane Library, focusing on publications from the last two decades. Key search terms included "malignant hyperthermia," "treatment," "management," "dantrolene," and "anesthesia complications." Articles were selected based on relevance, quality, and contributions to current knowledge on MH management. Results: The review highlights the critical role of early diagnosis, the use of dantrolene as the primary pharmacological intervention, and supportive measures to manage complications. Key findings include: 1) Early Recognition and Diagnosis: Identifying early signs such as hypercapnia, tachycardia, and muscle rigidity is crucial. Genetic testing and caffeine-halothane contracture tests remain gold standards for diagnosis. 2) Pharmacological Management: Dantrolene remains the cornerstone of MH treatment, with recommendations for its administration and dosing regimens. New formulations of dantrolene have improved ease of use and response times. 3) Supportive Care: Managing hyperthermia, acidosis, and electrolyte imbalances through cooling measures, intravenous fluids, and bicarbonate therapy is essential. 4) Preventive Strategies: Genetic counseling and preoperative screening for high-risk individuals are critical for preventing MH episodes. Safe anesthesia practices, including the avoidance of triggering agents, are emphasized. Conclusion: The management of MH requires a multifaceted approach involving prompt identification, immediate administration of dantrolene, and comprehensive supportive care. Advances in pharmacological treatments and preventive strategies have significantly improved patient outcomes. Ongoing research and education are necessary to further enhance therapeutic protocols and reduce the incidence of MH-related complications.

Keywords: Malignant hyperthermia, Dantrolene, Anesthesia, Pharmacogenetics, Hyperthermia management, Supportive care, Preoperative screening.