MALIGNANT HYPERTHERMIA: MODERN APPROACHES TO DIAGNOSIS, TREATMENT AND PROPHYLAXIS
DOI:
https://doi.org/10.11603/1811-2471.2026.v.i2.16393Keywords:
malignant hyperthermia, dantrolene, diagnosis, anesthesia, review, RYR1Abstract
SUMMARY. Malignant hyperthermia (MH) remains a rare, life-threatening pharmacogenetic complication of anesthesia. Historically, mortality approached 80 % but has declined to 5-15 % following the implementation of dantrolene sodium, the only specific antidote. The relevance of this problem for Ukraine is particularly high. We identified a dangerous regulatory paradox: while Ministry of Health (MOH) clinical protocols (namely, Order No. 430) mandate the use of dantrolene, the drug itself lacks active registration in the State Register of Medicines.
This aim – to analyze and systematize current scientific data on the epidemiology, genetics, clinical diagnosis, and management protocols for MH. Furthermore, we critically analyzed the problem of dantrolene accessibility in Ukraine and its consequences for patient safety.
Material and Methods. We conducted an analytical literature review. We searched international databases including PubMed (MEDLINE), Google Scholar, The Cochrane Library, and StatPearls. The analysis included meta-analyses, systematic reviews, clinical guidelines, and original research.
Results. Our analysis confirms that genetic susceptibility (carrier status for mutations, primarily in the RYR1 gene) ranges from 1:400 to 1:2,000, which significantly exceeds the frequency of clinical crises (1:10,000–1:250,000). This discrepancy results from incomplete gene penetrance and the fact that most carriers are never exposed to trigger agents (volatile anesthetics, succinylcholine). We found that the key early diagnostic sign of MH is not hyperthermia (a late symptom), but rather an unexplained, sudden, and persistent rise in end-tidal CO₂ (hypercapnia). Moreover, muscle rigidity (especially masseter muscle rigidity) and tachycardia often precede the temperature increase. The review confirms that clinicians must differentiate MH from neuroleptic malignant syndrome (NMS), serotonin syndrome, and sepsis. The cornerstone of management involves immediate cessation of triggers, hyperventilation with 100 % oxygen, and emergency intravenous administration of dantrolene sodium at 2.5 mg/kg. As a result, a 30-minute delay in antidote administration significantly increases the risk of complications (e.g., rhabdomyolysis, acute kidney injury, DIC). Prophylaxis in susceptible individuals consists of complete avoidance of triggers and utilizing Total Intravenous Anesthesia (TIVA).
Conclusions. MH remains a significant challenge where patient survival depends on early diagnosis (via hypercapnia) and immediate access to dantrolene. The identified discrepancy between approved MOH protocols, which mandate dantrolene, and its actual lack of registration in Ukraine constitutes a critical threat to patient safety. This problem demands an urgent resolution from regulatory authorities and professional associations.
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