How Can Malignant Hyperthermia Be Prevented?
Malignant hyperthermia is an autosomal dominant disease, it is a rare disease.1 The exact incidence of malignant hyperthermia is not known, however the “incidence of malignant hyperthermia during general anesthesia ranges from 1: 5,000 to 1: 50,000 – 100,000”. The actual incidence of malignant hyperthermia might be more than the reported cases as all patients with malignant hyperthermia might not undergo anesthesia in their lifetime or they may undergo a minor surgery with minimum exposure or the symptoms might be very minimal that malignant hyperthermia would not be diagnosed or some may develop malignant hyperthermia after several anesthesia sessions.
Currently, the mortality rate of malignant hyperthermia is less than 5% with early diagnosis of malignant hyperthermia and proper management. The morbidity is about 34% which is quite high despite the low mortality rate; therefore, patients and doctors should be more focused on prevention of malignant hyperthermia and early diagnosis and treatment of malignant hyperthermia.
How Can Malignant Hyperthermia Be Prevented?
Prevention should be done as a collaborative effort by both doctors and patient. There is no point in pointing fingers to one party after a serious event.
Avoiding Triggering Agents
This is the best prevention method. The triggering factors such as volatile inhalation anesthetic agents, depolarizing muscle relaxants, strenuous exercises and excess heat should be avoided to prevent malignant hyperthermia. When a patient is diagnosed with malignant hyperthermia, the doctor should give them a proper diagnosis card with all the details and a medical alert bracelet to be worn. You should wear that alert bracelet always, so, that even during an emergency the doctors who are operating know that you have malignant hyperthermia. The anesthetist should avoid the triggering anesthetic agents and use alternatives to induce anesthesia.
Use Of Dantrolene Sodium
Dantrolene is the only specific drug treatment available of malignant hyperthermia.2 The mortality rates have significantly reduced from 70-80% to 10% after the use of dantrolene to treat malignant hyperthermia patients. One reason for the mortality rates to be <5% is treatment with dantrolene. Many hospitals theaters in developed countries have immediate access to dantrolene in an emergency (they have dantrolene regularly stored in the theaters). But most of the developing country hospitals and even some developed countries do not have regular dantrolene stores and lacks immediate access to dantrolene, some hospital depends on other hospitals to purchase dantrolene in an emergency which takes time and time matters in a case of malignant hyperthermia. Therefore, hospital staff, anesthetists should be educated more about the importance of having immediate dantrolene access for an emergency.
Avoiding Strenuous Exercises And Exposure To Excess Heat
Strenuous exercises and excess heat also considered as triggering factors of malignant hyperthermia, even though this is not proved properly there have been some cases reported. Therefore, you should avoid strenuous exercises and exposure to excess heat.
Education About Malignant Hyperthermia
Education about malignant hyperthermia, the symptoms and signs, how to diagnose and how to manage a patient with malignant hyperthermia is very important for a doctor especially an anesthetist so that the anesthetist will know exactly how to manage an undiagnosed patient who develops malignant hyperthermia. This can reduce the high morbidity rate associated with malignant hyperthermia.
As a patient you should also be knowledgeable about the triggering agents and generally about the disease to prevent it.
Testing Other Family Members
When a patient is diagnosed with malignant hyperthermia, it is the doctor’s responsibility to test the other family members for malignant hyperthermia as well to prevent it from occurring.
Mortality rate of malignant hyperthermia is less than 5% with early diagnosis of malignant hyperthermia and proper management. The morbidity is about 34% which is quite high despite the low mortality rate. Prevention of malignant hyperthermia can be done by avoiding triggering factors, wearing a medical alert bracelet always, use of dantrolene sodium for immediate treatment of malignant hyperthermia patients, regularly maintain adequate stores of dantrolene; adequate knowledge about malignant hyperthermia, proper diagnosis and how to manage a patient with malignant hyperthermia in an emergency; and testing other family members.
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