Malignant hyperthermia is a clinical syndrome where the patient develops hypermetabolism of skeletal muscles. MH occurs when the patient is exposed to certain triggering anesthetic drugs and muscle relaxants such as succinylcholine. Although rare, its occurrence manifests as life-threatening with a high and rapid increase of myoplasmic calcium in skeletal muscles. Patients susceptible to MH can develop acute and life-threatening syndromes such as extreme temperature rise, rhabdomyolysis, and kidney failure.

Occurrence of Malignant Hyperthermia.

MH incidence of occurrence affects approximately 1 per 50,000 to 100 000 patients in the United States. Malignant hyperthermia is a genetic mutation that occurs 1 in 3,000. Children aged 19 years and below are more susceptible to the genetic mutation for malignant hyperthermia than older adults. The condition is hard to express in everyday life but usually occurs during or after surgical procedures which exposes individuals to succinylcholine and volatile anesthetics. MH does not necessarily just occur during the clinical process but also post-surgery, which is why medical providers must be careful when handling malignant hyperthermia patients. The most obvious sign of the condition is temperature increase at a rate of 1-2 ℃.

Importance of Performing Malignant Hyperthermia Test for Outpatient Surgery Patients

Like any other life-threatening clinical condition, testing outpatients for malignant hyperthermia presents the service providers with many preventive measures. There are many benefits benefits of performing Malignant Hyperthermia NGS testing for outpatient surgery patients including:

  1. Alternative for Anesthetic Drugs. Upon the test and finding of the possibility of developing the syndrome, the anesthesia administrator is alerted not to use drugs that will cause its occurrence. Safer alternative precautions can be used to provide safer anesthesia for the patients.
  2. Establish Preparedness. Test results give the service provider a clear guide of the best operating requirements.
  3. Plan for  Medical Follow-up. Patients with a high risk of malignant hyperthermia need a 24 hour medical follow-up after the surgery. Planning follow-ups ensures that risks and adverse reactions are monitored, and there is emergency care readily available through administering antidote dantrolene and other clinical therapies.
  4. Record Keeping. Testing for malignant hyperthermia is essential for medical reports and records for future treatment of the patients. It also generates statistics essential for medical care preparedness for patients with malignant hyperthermia.
  5. Reduced Complication Risk. According to the American Society for Anesthesiology, it is prime to conduct tests for malignant hyperthermia for patients to ensure their safety and reduce the risk of postoperative mortality.

What Types of Tests Can Be Done for High-Risk MH Individuals?

Regarding medical diagnosis of malignant hyperthermia, various tests can be done to determine if the patient has clinical susceptibility to HM.

  1. Caffeine halothane contracture test.
  2. Genetic testing which involves sequencing for ryanodine receptor genes (least invasive).
  3. The muscle-contracture test is a test that is globally accepted as a standard test using a biopsy to test the muscle contraction upon subjection to triggering drugs.

The Bottom Line.

Utilizing Malignant Hyperthermia NGS testing as a precautionary measure for surgery can reduce the fatality risk for safer operations and overall  anesthetic use. As Malignant hyperthermia cannot be diagnosed by physical examination utilizing NGS testing is key to have proper monitoring, antidotes and post-operation reviews in place and available., even if a patient history helps determine the probability of such syndrome. Therefore, when a patient being operated on is found to be susceptible to the syndrome, the room for operation should have close access to antidote, and the patient needs to be monitored closely for post-operation reviews.

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