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MALIGNANT HYPOTHERMIA North central Wisconsin is unique – no argument there. But this region stands out in the global medical community for a reason not many of you may be aware of – the region’s high incidence of malignant hyperthermia (MH), a rare life-threatening condition caused by exposure to general anesthetics. In general, undergoing an elective surgical procedure may pose some risks, but overall they are minimal. To minimize risks, the patient receives a comprehensive evaluation from the primary health care provider, surgeon, and anesthesiologist – each evaluates the patient’s risks and renders an opinion on the safety of the proposed surgery. Medical professionals in north central Wisconsin are aware of the risk for MH and screen patients appropriately. Let’s look more closely at malignant hypothermia. What is malignant hyperthermia? This is an inherited condition in which the body has a rare and unusual reaction to general anesthetics. The body’s ability to supply oxygen, remove carbon dioxide and regulate body temperature is affected. The patient will have a sudden onset of fever (105º F or higher), experiences a very rapid heartbeat, high blood pressure, difficulty breathing, and muscle rigidity. Due to the body’s high temperature, a rapid break down of the body’s muscles will occur, leading to dark urine and kidney problems. The brain may also be affected by the high body temperature. If these symptoms are not recognized during surgery, permanent damage to the lungs, brain, heart, kidneys, and muscles may occur. Thus, the anesthesiologist must be astute and carefully monitor the progress of every patient during surgery. Is this a common problem? In the U.S. incidence is dependent upon geography. The incidence rate can range from 1:200, 1:15,000, or 1:50,000. Research indicates that the genetics of north central Wisconsin’s Northern European ancestry may be responsible for the high incidence of MH. Family history and genetic screening are important because MH is a dominant gene. That means that if one parent has the disease, the child is at risk for the same problem. What is the screening process? The pre-operative evaluation by the anesthesiologist will involve questions concerning prior anesthetic problems. Also, the family history will be assessed. When a patient is at risk for the disease, specialized genetic testing can confirm the presence of the abnormal gene. Blood tests that look at body chemistries or a biopsy of skeletal muscle to assess abnormalities can also be given. The urine may also be evaluated for the presence of muscle chemicals. What is the treatment? Treatment must occur quickly and involves bringing down the body temperature with cooling blankets and Tylenol. A great deal of fluids will be given and a muscle relaxant, called Dantrolene, will be given intravenously, which can prevent death. What should I do? If a family member has had trouble with anesthesia in the past, you must report this to your doctor prior to surgery. Genetic counseling may be ordered on an elective basis and all family members at risk should be screened. General anesthesia should be avoided until the risks have been ruled out. If you are at risk, visit the Malignant Hyperthermia Association of the United States website at www.mhaus.org. |
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