Summary
Information was collected on 89 patients who responded to general anaesthetics with malignant hyperthermia. The syndrome occurred at the rate of about one in 14,000 anaesthetics among a hospital population of children. The patient mortality was 64 per cent. The finding that males were somewhat more commonly affected than were females does not contradict previous observations of dominant inheritance of the syndrome. About one-third of patients had relatives who were also affected with malignant hyperthermia, although a few patients had had previous uneventful general anaesthetics. The racial origin was varied. A pre-existing muscle or musculoskeletal disease was present more frequently than expected in patients who manifested rigidity.
Clinical manifestations followed the administration of a muscle relaxant or a potent inhalational agent, usually halothane. Fever was invariably present within the first one to two hours of the induction. Skeletal muscle rigidity occurred in more than two-thirds of cases. The use of anticholinergic drugs given preoperatively appeared to increase the incidence of rigidity. The use of non-depolarizing relaxants in vain attempts to overcome the rigidity has certainly not improved the chances of survival. The higher the absolute maximum temperature and the longer the duration of anaesthesia, the greater was the mortality rate.
It is possible that the cases with and without rigidity represent slightly different disorders. In cases characterized by rigidity there were often tachypnoea, tachycardia, arrhythmias, acute heart failure, late neurological deterioration, hypoxia, respiratory and metabolic acidoses, hyperkalaemia, hypocalcaemia, elevated serum enzymes, impaired blood coagulation, haemo- and myoglobinuria, oliguria, and muscle biopsy abnormalities.
Treatment included a wide variety of therapeutic measures. No particular agent could be credited with having improved the survival rate. So far, the most effective treatment was early detection and early cessation of anaesthesia.
Résumé
On a recueilli des renseignements chez 89 malades qui ont présenté de ľhypothermie maligne au cours ďune anesthésie générale. Le syndrome est apparu au taux ďun pour 14,000 anesthésies parmi la clientèle ďun hôpital pour enfants. Le taux de mortalité a été de 64 pour cent. La constatation que les sujets de sexe masculin sont le plus fréquemment affectés ne contredit pas les observations précédentes. Environ un tiers des malades avaient vu des membres de leur famille souffrir ďhyperthermie maligne, cependant que quelques uns avaient déjà subi une anesthésie générale sans incidents. Ľorigine raciale était variée. Il y avait une maladie musculaire ou musculosquelettique pré-existante plus souvent qu’on ne s’y attendait chez les malades qui ont manifesté de la rigidité.
Les manifestations cliniques se sont produites après ľadministration ďun myorésolutif ou ďun agent inhalatoire puissant, généralement ľhalothane. On a toujours observé de la fièvre au cours de la première ou de la deuxième heure à compter de ľinduction. La rigidité des muscles squelettiques s’est produite dans plus des deux tiers des cas. Ľusage de produits anticholinergiques en médication préopératoire a semblé augmenter la fréquence de la rigidité. Ľusage de résolutifs non dépolarisants, pour tenter en vain de combattre la rigidité, n’a certainement pas augmenté les chances de survie. Plus la température a été élevée et plus ľanesthésie a été longue, plus le taux de mortalité a été élevé. Il est possible que les cas avec ou sans rigidité représentent des pathologies légèrement différentes. Chez les malades présentant de la rigidité, il y avait souvent de la tachypnée, de la tachycardie, des arythmies, une défaillance cardiaque aigue, une détérioration neurologique tardive, de ľhypoxie, de ľacidose respiratoire et métabolique, de ľhypercaliémie, de ľhypocalcémie, une élévation des enzymes aériques, des troubles de la coagulation du sang, de ľhémoglobinurie, de la myoglobinurie, de ľoligurie et des anomalies de la biopsie musculaire.
Le traitement comprend une grande variété de mesures thérapeutiques. Aucun agent en particulier ne peut recevoir le crédit ďavoir amélioré le taux de survie. Pour le moment, le traitement le plus efficace a été le diagnostic précoce et la cessation rapide de ľanesthésie.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Brautigam, K. H. &Seybold, R. Fehler und Gefahren: Hyperthermic durch Allgemein-anaesthesie. Anaesthesist.18: 338 (1969).
Britt, B. A. &Gordon, R. A. Three Cases of Malignant Hyperthermia with Special Consideration of Management. Canad. Anaesth. Soc. J.16: 99 (1969).
Britt, E. A.;Locher, W. G.; &Kalow, W. Hereditary Aspects of Malignant Hyperthermia. Canad. Anaesth. Soc. J.16: 89 (1969).
Britt, B. A. &Kalow, W. Hyperrigidity and Hyperthermia Associated with Anaesthesia. Ann. New York Acad. Sc.151: 947 (1968).
Capizzi, L. S.;Phillips, O. C.; &Harris, L. C. Malignant Hyperthermia during Anaesthesia. Anesthesiology.31: 97 (1969).
Carpenter, G. G.;Auerbach, V. H.;Digeorge, A. M.;Mayer, B. W.; &Schutta, H. S. Rhabdomyolysis after Routine Administration of Succinylcholine in Children. Soc. Paediat. Res. 29–30: 175 (1966).
Churchill-Davidson, W. Malignant Hyperpyrexia. Brit. Med. J.3: 69 (1968).
Cody, J. R. Muscle Rigidity Following Administration of Succinylcholine. Anesthesiology.29: 159 (1968).
Crocker, D.;Blum, H.;Adams, J. G.; &Smith, R. M. Hyperthermia during Anaesthesia. Anaesth. & Analg.48: 789 (1969).
Cullen, W. G. Malignant Hyperpyrexia during General Anaesthesia: A Report of Two Cases. Canad. Anaesth. Soc. J.13: 437 (1966).
Daniels, J. C.;Polayes, I. M.;Villar, R.; &Hehre, F. W. Malignant Hyperthermia with Disseminated Intravascular Coagulation during General Anaesthesia: A Case Report. Anaesth. & Analg.48: 877 (1969).
DavIEs, L. E. &Graves, H. B. Hyperpyrexia and Death Associated with General Anaesthesia. Canad. Anaesth. Soc. J.13: 447 (1966).
Davtes, R. M.;Packer, K. J.;Titel, J.; &Whitmarsh, V. Malignant Hyperpyrexia: Two Case Reports. Brit. J. Anaesth.41: 703 (1969).
Denborough, M. A. &Lovell, R. R. H. Anaesthetic Deaths in a Family. Lancet,ii: 45 (1960).
Denborough, M. A.;Forster, J. F. A.;Lovell, R. R. H.;Maplestone, P. A.; &Villers, J. D. Anaesthetic Deaths in a Family. Brit. J. Anaesth.34: 395 (1962).
Dillon, J. B. Fulminating Hyperthermia during Anaesthesia. New York State J. Med.68: 2566 (1968).
Gibson, J. A. &Gardiner, D. M. Malignant Hypertonic Hyperpyrexia Syndrome. Canad. Anaesth. Soc. J.16: 106 (1969).
Gordon, R. A. Malignant Hyperpyrexia during General Anaesthesia. Canad. Anaesth. Soc. J.13: 415 (1966).
Guedel, A. E. Inhalation Anaesthesia. 2nd ed., New York: Macmillan (1952), p. 110.
Hogg, S. &Renwick, W. Hyperpyrexia during Anaesthesia. Canad. Anaesth. Soc. J.13: 429 (1966).
Katsya, H. Malignant Hyperpyrexia: A Case Report. Japan J. Anaesth.44: 661 (1969).
Knight, R. T. Elevation of Body Temperature during Anaesthesia and Its Control. Anaesth. & Analg.21: 117 (1942).
Lavoie, G. Hyperpyrexia during General Anaesthesia: A Case Report. Canad. Anaesth. Soc. J.23: 444 (1966).
Martin, J. T. Fulminant Hyperthermia. J.A.M.A.204: 183 (1968).
Marx, G. F.;Steen, S. N.;Berenyi, K. J.;Erlanger, H. L.;Foster, E. S.;Kepes, E. R.;Jadwat, C. M.;Potash, R. S.; &Schapira, M. Fulminating Hyperthermia during Anaesthesia: A Case Report. New York State J. Med.68: 2566 (1968).
Mogavock, H. A Simple Method for the Early Detection of the Malignant Hyperpyrexia of Anaesthesia and Hypothesis. Ir. J. Med. Sc. 2: 285 (1969).
Murray, B. R. P. &Williams, P. A. D. Malignant Hyperpyrexia during Anaesthesia for CoUectomy. Brit. Med. J.1: 488 (1969).
P.S.M., Mass. Comment on Case Report #247. Am. Soc. Anesth. Newsletter.26: 10 (1962).
Purkis, I. E.;Horrelt, O.;De Young, G.;Fleming, R. A. P.; &Langley, G. R. Hyperpyrexia Following Anaesthesia in a Second Member of a Family with Associated Coagulation Defect. Canad. Anaesth. Soc. J.14: 183 (1967).
Quinn, J. R.;Spatz, S. S.;Shensa, D. R.; &Esway, J. K. Malignant Hyperthermia during an Oral Surgical Procedure: Report of a Case. J. Oral Surg.27: 266 (1969).
Relton, J. E. S.;Creighton, R. E.;Johnston, A. E.;Pelton, D. A.; &Conn, A. W. Hyperpyrexia in Association with General Anaesthesia in Children. Canad. Anaesth. Soc. J.13: 419 (1966).
Relton, J. E. S.;Creighton, R. E.;Conn, A. W.; &Nabeta, S. Generalized Muscular Hypertoniaty Associated with General Anaesthesia: A Suggested Anaesthetic Management. Canad. Anaesth. Soc. J.14: 22 (1967).
Relton, J. E. S.;Creighton, R. E.; &Conn, A. W. Fulminant Hyperpyrexia Associated with Anaesthesia. Anaesthesia.23: 253 (1968).
Ruttle, L. D. Case Report #247: Death Occurred in the Operating Room Following Extreme Hyperthermia during an Elective Cholecystectomy. Am. Soc. Anesth. News- letter.26: 21 (1962).
Saidman, L. J.;Havard, E. S.; &Eger, E. I. Hyperthermia during Anesthesia. J.A.M.A.190: 73 (1964).
Satnick, J. H. Hyperthermia under Anesthesia with Regional Muscle Flaccidity. Anesthesiology.30: 472 (1969).
Soderberg, M. J. Anesthesia and Malignant Hyperpyrexia. J. Am. A. Nurse Anesthetists. Oct., 368 (1969).
Stephen, C. R. Fulminant Hyperthermia during Anaesthesia and Surgery. J.A.M.A.202: 178 (1967).
Takamatsu, O. Three Cases of Malignant Hyperpyrexia during Anaesthesia. Japan J. Anaesth.44: 665 (1969).
Thut, W. H. &Davenport, H. T. Hyperpyrexia Associated with Succinylcholine-Induced Muscle Rigidity: A Case Report. Canad. Anaesth. Soc. J.13: 425 (1966).
W.A.C., Calif. Comments on Case Report #247. Am. Soc. Anesth. Newsletter.26: 30 (1962).
Wilson, R. D.;Dent, T. E.;Traber, D. L.;McCoy, N. R.; &Allen, C. R. Malignant Hyperpyrexia with Anesthesia. J.A.M.A.202: 183 (1967).
Beldavs, J. Personal Communication. Windsor, Ontario (1969).
Bezai, K. Personal Communication. Detroit, Michigan (1969).
Brooks, P. Personal Communication. Orlando, Florida (1969).
Craig, D. Personal Communication. Montreal, Que. (1969).
Dix, G. W. Personal Communication. Toronto, Ontario ( 1969 ).
Foster, N. E. Personal Communication. Calgary, Alberta (1968).
Gygi, A. Personal Communication. Geneva, Switzerland ( 1969 ).
Kilbourn, R. M. Personal Communication. Kitchener, Ontario ( 1967 ).
Kirkebeck, E. Personal Communication. Calgary, Alberta (1969).
Kruse, J. C. Personal Communication. Jacksonville, Florida (1968).
Kurita, K. Personal Communication. Modesto, California (1969).
Locher, W. G. Personal Communication. Wausau, Wisconsin (1968).
Minuck, M. Personal Communication. Winnipeg, Manitoba (1969).
Pitonyak, A. D. Personal Communication. Pontiac, Michigan (1969).
Raymon, F. &Bruce, D. Personal Communication. Chicago, III. (1969).
Rein, J. Personal Communication. Suffern, N.Y. (1969).
Rigley, F. Personal Communication. Montreal, Quebec (1968).
Sanderson, G. Personal Communication. Buffalo, N.Y. (1968).
Stephen, C. R. Personal Communication. Dallas, Texas (1967).
Wade, J. Personal Communication. Winnipeg, Manitoba (1969).
Watson, R. L. Personal Communication. Washington, D.C. (1969).
Webb, G. E. Personal Communication. Madison, Wisconsin (1968).
Orkin, L. Personal Communication. New York, N.Y. ( 1969).
Ryan, J. F. &Papper, E. M. Malignant Fever during and Following Anesthesia. Anesthesiology.32: 196 (1970).
Seeman, P. Personal Communication. Toronto, Ontario ( 1968 ).
Britt, B. A. &Kalow, W. Malignant Hyperthermia: Aetiology Unknown. Canad. Anaesth. Soc. J.17: 316 (1970).
Lillehei, R. C.;Longerbeam, J. K.;Bloch, J. H.; &Manax, W. G. The Modern Treatment of Shock Based on Physiologic Principles. Clin. Pharmacol. Therap.5: 63 (1964).
Koch-Weser, J. Mechanism of Digitalis Action on the Heart. New England J. Med.277: 469 (1967).
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Britt, B.A., Kalow, W. Malignant hyperthermia: A statistical review. Can. Anaesth. Soc. J. 17, 293–315 (1970). https://doi.org/10.1007/BF03004694
Issue Date:
DOI: https://doi.org/10.1007/BF03004694