The changing face of malignant hyperthermia: less fulminant, more insidious. Anaesth Intensive Care Jul 2015.
Due to modern anaesthetic techniques, the clinical presentation of malignant hyperthermia is becoming increasingly insidious. The 4 case reports in this article highlight such presentations. Fulminant MH is characterised by a combination of rapidly evolving signs of hypermetabolism (hypercapnia, tachycardia, hypertension, hyperthermia), muscular symptoms (masseter spasm, rigidity) and rahdbdomyolysis. As anaeshtetists we should be aware of the more subtle signs of MH which include:
- Foremost: persistent, unexplained and difficult-to-correct hypercapnia
- Rapidly increasing and/or inappropriately elevated body temperature
- Masseter spasm following suxamethonium
- Clinical or biochemical evidence of rhabdomyolysis: increased postoperative CK level, voiding of cola-coloured urine (myoglobinuria), with or without hyperkaelamia