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Malignant hyperthermia when dantrolene is not readily available

BMC Anesthesiology volume 21, Article number: 119 (2021) Cite this article

Abstract

Background

Malignant hyperthermia is a rare but life-threatening pharmacogenetic muscle disorder characterized by abnormal hypermetabolic reactions and commonly triggered in susceptible individuals by volatile anesthetics or succinylcholine, or both. Unfortunately, the specific medicine dantrolene is not readily available in many countries including China. The aim of this study was to find the characteristics of malignant hyperthermia under the situation that dantrolene is not readily available.

Methods

The cases of malignant hyperthermia reported on the most commonly used databases in China from 1985 to 2020 were analyzed. The inclusion criteria were the MH episodes only related to anesthesia. The exclusion criteria were dubious MH episodes only caused by Ketamine administration or MH episodes irrelevant to anesthesia. Independent samples t-test and Pearson’s chi-squared test were applied to assess the difference between the survived and death cases.

Results

Ninety-two cases of malignant hyperthermia reported on the most commonly used databases in China from 1985 to 2020 were analyzed. Median (IQR [range]) age was 18.5 (11.8–37.0 [0–70.0]) years. Compared with the survived cases, the death cases had higher maximum end-tidal partial pressure of CO2 (P = 0.033), the maximum arterial partial pressure of CO2 (P = 0.006), temperature first measured when the patient was first discovered abnormal (P = 0.012), and maximum temperature (P < 0.001). Besides, the death cases had less minimum pH (P < 0.001) and higher potassium (P < 0.001) and were more likely to have coagulation disorders (p = 0.018). Concerning treatment, cases used furosemide (P = 0.024), mannitol (P = 0.029), blood purification treatment (P = 0.017) had the advantage on the outcome. Creatine phosphokinase, myoglobin, and MB isoenzyme of creatine phosphokinase differed greatly among cases during the first week. 43 (46.7%) cases had congenital diseases. 12 (13.0%) cases were reported with abnormal laboratory test results or abnormal signs that are possibly relevant before anesthesia.

Conclusions

In countries that dantrolene is not readily available, early warning, diagnosis, and prompt effective therapies are crucial for MH patients to survive.

Peer Review reports

Background

Malignant hyperthermia (MH) is a rare but life-threatening pharmacogenetic muscle disorder characterized by abnormal hypermetabolic reactions and commonly triggered in susceptible individuals by volatile anesthetics or succinylcholine, or both. The incidence of MH is estimated between 1/5000 and 1/250000 anesthetics [1,2,3,4,5]. However, the real prevalence of MH susceptibility is very much higher because most people with MH-related genetic mutations never undergo any anesthesias during their lives. Indeed, the predicted genetic prevalence is reported between 1/2000 and 1/3000, and another study reported the prevalence may be as high as 1/400 [6,7,8]. Malignant hyperthermia mortality reached up to 70% before the introduction of dantrolene [9]. Another study showed the mortality rate was 64% before administration approval of dantrolene [10]. Unfortunately, the specific medicine dantrolene is not readily available in many countries. Due to low incidence, high cost, and short life span, it is quite difficult to get dantrolene when MH episodes happen in the great majority of hospitals in China as well. In China, MH has been often mostly reported in the form of case reports. In the vast majority of cases, dantrolene was not administered. The aim of this study was to find the characteristics of MH under the situation that dantrolene is not readily available.

Methods

The keyword `malignant hyperthermia` was used to search in Wanfang Database, China National Knowledge Infrastructure, China Science and Technology Journal Database, and China Biology Medicine Database, which are the most commonly used databases in China. Exclusion criteria were dubious MH episodes only caused by Ketamine administration or MH episodes irrelevant to anesthesia.

The MH clinical grading scale (CGS) was used to qualitatively assess the probability of the MH cases. CGS score range, MH rank, and qualitative probability are shown in Table 1. Based on the scoring rule, if more than one indicator represent a single process, only count the indicator with the highest score [11]. For example, both increased creatine kinase (CK) to more than 10,000 IU after anesthetic administration without succinylcholine (15 points) and cola-colored urine after anesthetic administration (10 points) represent the same process: muscle breakdown. Therefore, an individual with the above two abnormal signs and laboratory results would have only 15 points, not 25 points. But if authors offered the ranks or CGS scores, they were directly adopted.

Table 1 Clinical grading scale
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Statistical analysis was performed using SPSS v24 (IBM Corp, Armonk, NY, USA). For continuous variables, for instance, age, maximum end-tidal and arterial CO2, temperature when the patient was first discovered abnormal, etc. in which survival and death groups of variables were compared. Descriptive statistics were expressed as mean (SD) and median (IQR [range]), and independent t-test were used. For categorical variables, for instance, gender, generalized muscular rigidity, cola-colored urine, etc., Pearson’s chi-squared test was used to test the difference between the variables of the two groups by number (proportion). The P-value < 0.05 was considered statistically significant.

Results

Totally 139 relevant articles were retrieved. Dubious MH episodes only caused by Ketamine administration and MH episodes irrelevant to anesthesia were ruled out. The process of identifying the eligible articles is outlined in Supplemental Figure 1. Eventually, 110 articles and 92 cases (85.2% of MH episodes relevant to anesthesia administration reported) were included in the final analysis, but not all data were recorded and reported for these 92 cases [12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76,77,78,79,80,81,82,83,84,85,86,87,88,89,90,91,92,93,94,95,96,97,98,99,100,101,102,103,104,105,106,107,108,109,110,111,112,113,114,115,116,117,118,119,120,121]. Therefore, some variables included less than 92 cases and some patients’ CGS points were underestimated or not estimated. 63 (68.5%) cases were MH rank 6 representing the MH probability is almost certain. 15 (16.3%) cases were MH rank 5 representing the MH probability is very likely. 4 (4.3%) cases were MH rank 4 representing the MH probability somewhat greater than likely.

Cases sources characteristics and demographics

One hundred and ten articles and 92 cases in this study involved 13 departments (Fig. 1) and different years (Fig. 2). The median age was 18.5 (11.8–37.0 [0–70.0]) years. 72 (78.3%) cases were male and 20 (21.7%) cases were female (Fig. 3).

Fig. 1
figure 1

Department distribution of MH cases

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Fig. 2
figure 2

Occurrence year distribution of MH cases

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Fig. 3
figure 3

Age distribution of MH cases. Blue, male; red, female

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Outcomes

A total of 50 (54.3%) cases survived and 42 (45.7%) cases died. From 1985 to 2010 the total mortality was 33 (54.1%) cases, whereas the total mortality was down to 9 (29.0%) cases from 2011 to 2020 (Table 2). Compared with the previous phase, the total mortality in the latter phase decreased nearly by half (P = 0.023). Of total cases, 8 (8.7%) cases were used dantrolene. Of the 50 survival cases excluding the 8 cases that used dantrolene, there were 29 cases with time data beginning to improve after treatment and the median (IQR [range]) time was 1.0 (0.8–2.0 [0.3–5]) hours.

Table 2 Outcome of MH cases. Values are number (proportion)
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Anesthetics

Table 3 shows the frequency with which volatile anesthetics or succinylcholine, or both, were administered. Of 76 cases with anesthetics data, five cases used succinylcholine without volatile anesthetic, 17 cases used succinylcholine and volatile anesthetic, and 71 cases only used volatile anesthetic including 32 (45.1%) cases isoflurane, 19 (26.8%) cases used sevoflurane, 18 (25.4%) cases used enflurane, and 2 (2.8%) cases used halothane.

Table 3 Anesthetics of MH cases. Values are number (proportion)
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The first clinical sign

Of 83 cases with time data from induction of anesthesia to first abnormal sign interval, the median (IQR [range]) time was 1.3 (0.5–2.0 [0–18]) hours. The most frequent initial signs were hypercarbia (31 (33.7%)), sinus tachycardia (23 (25.0%)), hyperthermia (18 (19.6%)), and masseter spasm (10 (10.9%)) (Table 4).

Table 4 The first clinical sign of MH cases. Values are number (proportion)
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Comparisons of survived and death cases

Analysis of the age, gender, history of congenital disease, clinical sign, laboratory result, treatment, and CGS scores between the survived and death cases were as follows (Table 5). Compared with the survived cases, the death cases had higher maximum end-tidal partial pressure of carbon dioxide (PCO2) (P = 0.033), maximum arterial PCO2 (P = 0.006), temperature first measured when the patient was first discovered abnormal (P = 0.012), and maximum temperature (P < 0.001). Besides, the death cases had less minimum pH (P < 0.001) and higher potassium (P < 0.001) and were more likely to have coagulation disorders (p = 0.018). Concerning treatment, cases used furosemide (P = 0.024), mannitol (P = 0.029), blood purification treatment (P = 0.017) had the advantage on the outcome.

Table 5 Comparisons of survived and death cases. Values are mean (SD), median (IQR [range]) or number (proportion)
Full size table

Table 5 Comparisons of survived and death cases. Values are mean (SD), median (IQR [range]) or number (proportion).

Drug treatment

Of 54 cases with vasoactive drugs data, the most commonly used medications were dopamine (57.4%), epinephrine (53.7%), and norepinephrine (25.9%) (Supplemental Table 1). Besides the vasoactive agents mentioned in Supplemental Table 1 and agents mentioned in Table 5, 11 cases (12.9%) were administered insulin, and 18 cases (19.6%) were administered antibiotics.

Enzymes

Of total cases, 13 cases were recorded more enzyme data [14, 24, 27, 31, 34, 40, 53, 87, 88, 91, 95, 109, 116]. The CGS score of the patient six, eight and ten were graded by original authors. As Figs. 4, 5 and 6 shown, creatine phosphokinase (CPK), myoglobin, and creatine phosphokinase myocardial band (CPK-MB) varied greatly during the first week, and there were significant differences among these patients as well.

Fig. 4
figure 4

Changes of creatine phosphokinase. CPK, creatine phosphokinase

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Fig. 5
figure 5

Changes of myoglobin

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Fig. 6
figure 6

Changes of CPK-MB. CPK-MB, creatine phosphokinase myocardial band

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History of congenital disease and abnormal characteristics before anesthesia

43 (46.7%) cases had congenital diseases. 12 (13.0%) cases were reported with abnormal laboratory test results or abnormal signs that are possibly relevant before anesthesia. Among these cases, 6 (6.5%) cases were with increased CPK, 4 (4.3%) cases with increased alkaline phosphatase (ALP), 2 (2.2%) cases with increased CPK-MB,1 (1.1%) cases with increased lactic dehydrogenase (LDH), and 3 (3.3%) cases were recorded with a mildly elevated body temperature of unknown origin.

Diagnostic testing

Of the total cases, 7 (7.6%) cases took relevant examinations and showed positive results. In three cases, the muscles of the patients were soaked in succinylcholine solutions and all of them tested positive and contracted strongly. Muscle biopsy was performed in four cases, among which one case showed hyaline degeneration in quadriceps femoris, one case with vacuolar degeneration and myolysis in quadriceps femoris, one case with severe vacuolar degeneration in striated muscle, and one case with inflammatory and degeneration in gastrocnemius muscle. In another case, as Fig. 7 shown, seven members of the immediate family of the patient took the genetic testing and six members in red were tested positive and have MH susceptibility [45].

Fig. 7
figure 7

RYR1 testing result in one family

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Discussion

Totally 110 articles and 92 cases were used from the most commonly used databases in China. Exclusion criteria were dubious MH episodes only caused by Ketamine administration or MH episodes irrelevant to anesthesia. This study may be limited by incomplete patient data and underreporting, but analysis bias seems to be minimal because there were no significant differences between comparisons of survived and death cases.

For the incident departments, they were concentrated in departments of orthopedics, stomatology, and hepatobiliary surgery. Around half of the incident years focused on 2001–2010. The male to female of MH cases was 3.5:1. More than half of MH cases focused on the 7–18 and 19–40 demographic. In all these MH cases reported, the total mortality was 42 (45.7%), less than the mortality rate 64–70% reported before administration of dantrolene [9, 10]. Even in the absence of dantrolene, the mortality was down to 36.0% from 2011 to 2020. In terms of anesthetics, more than half of all these cases were administered volatile anesthetic without succinylcholine, mainly including isoflurane, sevoflurane, and enflurane. Besides, the most frequent initial signs of these cases were hypercarbia, sinus tachycardia, hyperthermia, and masseter spasm.

Although there were no significant differences between comparisons of survived and death cases, some clues were still found from the analysis. From the comparisons, the death cases had higher maximum end-tidal PCO2, maximum arterial PCO2, temperature first measured when the patient was first discovered abnormal, maximum temperature and potassium, and had more serious metabolic acidosis and more possibility of coagulation disorders. On the treatment side, cases that used furosemide, mannitol, blood purification treatment had a significant advantage on the outcome, which showed renoprotective therapies play important roles in outcomes in these MH cases.

The 13 cases with more enzyme data were all at MH rank 6. But there were wide differences in concentration of CPK, myoglobin, and CPK-MB between these `almost certain` cases. Therefore, the low size of these enzyme value might be that they can’t be used to rule out MH episode or determine the severity of MH, which confirm the study made by Carpenter et al. [122] that different RYR1 variants vary in the severity of CPK concentration. Besides, most of the cases’ pick time was on the second day, while occasional cases were on the third, fifth, or sixth day.

Almost half of these MH cases had congenital diseases. Around one in eight of the cases had abnormal enzyme results and mildly elevated body temperature. Therefore, anesthesiologists should take precautions when there are congenital diseases, these abnormal enzyme results or abnormally elevated body temperature for unexplained reason in pre-anesthesia patients and need to avoid administering volatile anesthetics and depolarizing neuromuscular blocking drugs muscle relaxants and strengthen monitoring in the susceptible individuals.

MH is inherited as an autosomal dominant disorder. Seven members of the immediate family of one patient all took the genetic testing, and except for the patient’s father the other six members all tested positive and have MH susceptibility. Therefore, once MH episode happens, all family members later need to be advised to take genetic testing, and if the test is positive they are further advised to make warning cards, bracelets, or necklaces with MH susceptible on them and carry them at all times to alert anesthesiologist, nurse anesthetists, and relevant staffs in case they need anesthesia in the future.

MH is a rare but life-threatening disorder. When body temperature is over 41 °C, disseminated intravascular coagulation (DIC) is the most common cause of death [1]. The possibility of any complication almost triples per two degrees Celsius rise in maximum body temperature [123]. The lack of dantrolene is the main limitation of MH treatment. Therefore, early warning and diagnosis and prompt effective therapies are crucial for MH patients to survive, especially in the countries that dantrolene is not readily available. There is a pressing need to establish an MH website and a telephone hotline available around the clock in China and countries that have not had these yet, and anesthesiologists, nurse anesthetists, and relevant staff are also urged to register MH episodes by real-name or anonymity. All information can be collected through the internet and directly uploaded to the national database in real-time. With the consent of those MH susceptible people, the identity information is uploaded. And the information can only be disclosed in internal systems among hospitals and related units. Once these people need to undergo anesthesia, anesthesiologists, nurse anesthetists, and relevant staff can receive alerts immediately. Besides, the need to carry out extensive publicity and education concerning MH incidence, clinical presentation, pathophysiology, diagnosis, and treatment is also urgent, not only on professionals and also ordinary people. Let as many people as possible realize the importance and seriousness. MH susceptible persons would volunteer to upload their identity information by themselves.

In conclusion, in countries that dantrolene is not readily available, early warning, diagnosis, and prompt effective therapies are crucial for MH patients to survive.

Availability of data and materials

The datasets used and analysed during the current study are available from the author on request.

Abbreviations

IQR:

Interquartile range

MH:

Malignant hyperthermia

CGS:

Clinical grading scale

CK:

Creatine kinase

SD:

Standard deviation

CO2 :

Carbon dioxide

ECG:

Electrocardiograph

PCO2 :

Partial pressure of carbon dioxide

T:

Temperature

HR:

Heart rate

BP:

Blood pressure

CPK:

Creatine phosphokinase

CPK-MB:

Creatine phosphokinase myocardial band

ALP:

Alkaline phosphatase

LDH:

Lactic dehydrogenase

DIC:

Disseminated intravascular coagulation

References

  1. Rosenberg H, Pollock N, Schiemann A, Bulger T, Stowell K. Malignant hyperthermia: a review. Orphanet J Rare Dis. 2015;10(1):93. https://doi.org/10.1186/s13023-015-0310-1.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Ording H. Incidence of malignant hyperthermia in Denmark. Anesth Analg. 1985;64(7):700–4.

    CAS  PubMed  Google Scholar 

  3. Lu Z, Rosenberg H, Li G. Prevalence of malignant hyperthermia diagnosis in hospital discharge records in California, Florida, New York, and Wisconsin. J Clin Anesth. 2017;39:10–4. https://doi.org/10.1016/j.jclinane.2017.03.016.

    Article  PubMed  Google Scholar 

  4. Halliday NJ. Malignant hyperthermia. J Craniofac Surg. 2003;14(5):800–2. https://doi.org/10.1097/00001665-200309000-00039.

    Article  PubMed  Google Scholar 

  5. Schneiderbanger D, Johannsen S, Roewer N, Schuster F. Management of malignant hyperthermia: diagnosis and treatment. Ther Clin Risk Manag. 2014;10:355–62. https://doi.org/10.2147/TCRM.S47632.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Riazi S, Kraeva N, Hopkins PM. Malignant hyperthermia in the post-genomics era: new perspectives on an old concept. Anesthesiology. 2018;128(1):168–80. https://doi.org/10.1097/ALN.0000000000001878.

    Article  PubMed  Google Scholar 

  7. Monnier N, Krivosic-Horber R, Payen JF, Kozak-Ribbens G, Nivoche Y, Adnet P, et al. Presence of two different genetic traits in malignant hyperthermia families: implication for genetic analysis, diagnosis, and incidence of malignant hyperthermia susceptibility. Anesthesiology. 2002;97(5):1067–74. https://doi.org/10.1097/00000542-200211000-00007.

  8. Gonsalves SG, Ng D, Johnston JJ, Teer JK, Stenson PD, Cooper DN, et al. Using exome data to identify malignant hyperthermia susceptibility mutations. Anesthesiology. 2013;119(5):1043–53. https://doi.org/10.1097/ALN.0b013e3182a8a8e7.

  9. Denborough M. Malignant hyperthermia. Lancet. 1998;352(9134):1131–6. https://doi.org/10.1016/S0140-6736(98)03078-5.

    Article  CAS  PubMed  Google Scholar 

  10. Britt BA, Kalow W. Malignant hyperthermia: a statistical review. Can Anesth Soc J. 1970;17(4):293–315. https://doi.org/10.1007/BF03004694.

    Article  CAS  Google Scholar 

  11. Larach MG, Localio AR, Allen GC, Denborough MA, Ellis FR, Gronert GA, et al. A clinical grading scale to predict malignant hyperthermia susceptibility. Anesthesiology. 1994;80(4):771–9. https://doi.org/10.1097/00000542-199404000-00008.

  12. An X, Wang Q, Qiu Y, Zhu Z, Ma Z, Li X. Rescue and nursing care of adolescent patients with scoliosis complicated by malignant hyperthermia during posterior orthopedic operations. J Clinic Nursing's Practicality. 2018;3(5):121–2.

    Google Scholar 

  13. Bai J, Chen X. The nursing experience of successfully treating a case of malignant hyperthermia during general anesthesia. Nursing Pract Res. 2011;8(8):122–4.

    Google Scholar 

  14. Cai Y, Chen L, Chen Y. A case of malignant hyperthermia after general anesthesia. Chin J Anesthesiology. 2007;27(6):575–6.

    Google Scholar 

  15. Cao G, Li J, Yan F. Nursing of patients with malignant hyperthermia after cleft palate repair. J Practical Medical Techniques. 2003;10(8):929.

    Google Scholar 

  16. Chen B. A case of death of malignant hyperthermia after cleft lip operation in children. Chin J Anesthesiology. 1995;15(4):192.

    Google Scholar 

  17. Chen B. A death case of sudden malignant hyperthermia during general anesthesia. Anthology Med. 1999;18(5):856–7.

    Google Scholar 

  18. Chen B, Wang P, Xu J, Tang T. A case report: malignant hyperthermia in general anesthesia. Forum of Anesthesia and Monitoring. 2010;17(6):462.

    Google Scholar 

  19. Chen H. A case report of malignant hyperthermia. Chinese Community Doctors. 2005;21(271):49.

    Google Scholar 

  20. Chen H, Ling H, Yu S. A case of malignant hyperthermia during ophthalmic operation in children. Guangdong Medical Journal. 2003;24(5):456.

    Google Scholar 

  21. Chen L. A case of malignant hyperthermia induced by general anesthetics. Tianjin Med J. 1998;26(4):254.

    Google Scholar 

  22. Chen Q, Gong L, Yang Q. Rescue of a patient with malignant hyperthermia in general anesthesia. J Nursing (China). 2008;15(8):35–6.

    Google Scholar 

  23. Chen X, Hao J. Successful treatment of malignant hyperthermia during scoliosis correction: a case report. Chin J Anesthesiology. 2012;32(3):384.

    Google Scholar 

  24. Chen Y, Wu J, Chen L, Yang X, Bai H. Malignant hyperthermia after general anesthesia in a child with cerebral palsy. Chin J Contemporary Pediatr. 2011;13(1):69–70.

    Google Scholar 

  25. Chen Y, Zhao T, Wu H, Chen G, Huang H, Xiong L. Successful treatment of malignant hyperthermia: a case report. J Clin Anesth. 2014;30(9):935–6.

    Google Scholar 

  26. Dai L. Analysis of one case of malignant hyperthermia induced by sevoflurane. Journal of Clinical Medical Literature. 2014;1(12):2285.

    Google Scholar 

  27. Deng M, Jiang X, Chen W, Zheng D, He X, Yuan H. Successful rescue of one case of suspected familial hereditary malignant hyperthermia. J Clin Anesth. 2020;36(2):204–5.

    Google Scholar 

  28. Dong Z. Nursing of malignant hyperthermia in an operation room. J Hebei Med. 2001;7(10):945.

    Google Scholar 

  29. Feng B. Treatment and nursing care of a patient with malignant hyperthermia complicated with hepatic and renal failure. Modern Nursing. 2005;11(16):1372–3.

    Google Scholar 

  30. Feng J, Li L, Huang Y, Zhou Z. A death case of malignant hyperthermia during anesthesia. Journal of Tianjin Medical University. 2001;7(2):292–3.

    Google Scholar 

  31. Gao J, Niu J, Wu S. A case of malignant hyperthermia in anesthesia. China J Emergency Resuscitation Disaster Medicine. 2007;2(12):748–9.

    Google Scholar 

  32. Hou X, Ding H, Feng Q. Experience of successful treatment and nursing of a patient with malignant hyperthermia in general anesthesia. J Nursing (China). 2010;17(6A):58–9.

    Google Scholar 

  33. Hu J, Zhang J, Zheng T, Gao Y. Success treatment of malignant hyperthermia in strabismus correction: a case report. Chin J Anesthesiology. 2010;30(9):1152.

    Google Scholar 

  34. Hu J, Chen M, Zhou D, Xiao X, Xiong X, Liu Y. Malignant hyperthermia caused by intravenous anesthesia: a case report and literature review. Chin J Integrated Traditional Western Nephrology. 2012;13(5):448–9.

    Google Scholar 

  35. Huang D, Zhong L, Yang D, Yu J. Rescuing experience of a patient with malignant hyperthermia. J Clin Anesth. 2002;18(4):215.

    Google Scholar 

  36. Huang M, Zeng X. A case of malignant hyperthermia after general anesthesia of cleft lip. J Dental Prevention and Treatment. 1998;6(4):29.

    Google Scholar 

  37. Huang S, Wang M. Emergency treatment and nursing of a patient with malignant hyperthermia during general anesthesia. J Nursing (China). 2003;4:97.

    Google Scholar 

  38. Huang W, Zhang M, Wan Z. A case of malignant hyperthermia induced by enflurane. Chin J Anesthesiology. 2001;17(2):114.

    Google Scholar 

  39. Huang Y, Chen J, Shen W, Li M. A case of intraoperative malignant hyperthermia. J Clin Anesth. 2004;20(6):329.

    CAS  Google Scholar 

  40. Ji W, Lin Z. Clinical treatment of malignant hyperthermia. Chin J Emergency Med. 2012;21(8):915–7.

    Google Scholar 

  41. Ke J, Yuan J, Jin F, Zhu Z, Zhou X, Xu Q, et al. Treatment of a patient with malignant hyperthermia induced by general anesthesia in facial plastic surgery. Chin J Aesthetic Medicine. 2011;20(4):671–2.

  42. Kong Q, Zhou Q. Postoperative malignant hyperthermia in children: two cases report. Hainan Med J. 2001;12(9):70–1.

    Google Scholar 

  43. Lan M, Jin X. Emergency nursing of a patient with malignant hyperthermia complicated by multiple organs failure. Chin J Practical Nursing. 2007;23:137.

    Google Scholar 

  44. Li F, Tang Q, Yang H, Tang Y. Experience of clinical pharmacists participating in the rescue of malignant hyperthermia. Central South Pharmacy. 2009;7(9):713–4.

    Google Scholar 

  45. Li K, Li T, Wang Y. Successful rescue of a patient with malignant hyperthermia and analysis of family gene test results. Perioperative Safety Quality Assurance. 2018;2(4):212–5.

    Google Scholar 

  46. Li Q, Li X, Zhou M, Yang L, Lu Z, Zhu M, et al. Comparison of success and failure factors in the rescue of two patients with malignant hyperthermia. J Clin Anesth. 2004;20(11):692–3.

  47. Li S, Weng X, Qiu G. Malignant hyperthermia during scoliosis correction: a case report. Chin J Orthopedics. 2000;20(8):510–1.

    Google Scholar 

  48. Li W, Yin J, Wang Y, Xu J. Malignant hyperthermia during general anesthesia in a patient with rare gene mutation. Chin J Anesthesiology. 2016;36(10):1272–3.

    Google Scholar 

  49. Li Z, Wu T. A case of malignant hyperthermia in anesthesia. Med J National Defending Forces in Southwest China. 2016;26(4):465–6.

    Google Scholar 

  50. Lin Y, Liao Y, Cai C. Malignant hyperthermia during anesthesia: a case report. J Sichuan University (Medical Science Edition). 2016;47(02):231.

    Google Scholar 

  51. Liu D, Zhao L, Gu S, Qian Y, Wang Y, Xia R, et al. A case of malignant hyperthermia caused by succinylcholine. Chin J Anesthesiology. 2001;21(2):105.

  52. Liu M, Lv L, Peng Y. Three cases of postoperative malignant hyperthermia in children. Chin J Practical pediatrics. 1999;14(10):628–9.

    Google Scholar 

  53. Liu Z, Fang L, Teng Y, Zhang F, Cui W, Yan M, et al. Clinical diagnosis and management of malignant hyperthermia. Chin J Emerg Med. 2007;16(10):1091–2.

  54. Lu X. Nursing of one patient with malignant hyperthermia during operation. Modern Nursing. 2005;11(21):1865–6.

    Google Scholar 

  55. Lu Y, Ding R, Zhang L. Rescue and nursing of a patient with sudden malignant hyperthermia during operation. J Modern Nursing. 2011;17(19):2335–6.

    Google Scholar 

  56. Lu Z, Chen Y, Tang L, Ling H, Gao C, Gu M, et al. Four cases of malignant hyperthermia during general anesthesia. Chin J Anesthesiology. 2003;23(12):935–6.

  57. Ma Y, Bai L, Wang R, Pan N. A case of malignant hyperthermia during general anesthesia. Med J Chinese People's Liberation Army. 2009;34(11):1385.

    Google Scholar 

  58. Mao Y. Clinical nursing of a case of malignant hyperthermia induced by anesthesia in three-dimensional spinal orthopedics. J Front Med. 2014;9(2):295–6.

    Google Scholar 

  59. Ouyang M, Qin Z, Chen Z, Xiao J, Liu X, Gu M. Successful treatment of explosive malignant hyperthermia in operation: a case report. J Southern Med University. 2010;30(11):2611–2.

    Google Scholar 

  60. Pan A. Analysis of a case of malignant hyperthermia during general anesthesia. J Medical Theory Pract. 2011;24(19):2329–30.

    Google Scholar 

  61. Shao X. A case of anesthesia complicated with malignant hyperthermia. Jiangsu Medical J. 2007;33(2):126.

    Google Scholar 

  62. Shi P. Nursing care of a patient with malignant hyperthermia. Chin J Nurs. 1992;7:316–7.

    Google Scholar 

  63. Shi Y. Nursing of a child with acute malignant hyperthermia spastic cerebral palsy during operation. Diet Health Care. 2018;5(52):144.

    Google Scholar 

  64. Song YS, Yang J. Malignant hyperthermia. J Clin Anesth. 1985;1(2):5–7.

    Google Scholar 

  65. Su Q, Jin F. Clinical nursing of a case of malignant hyperthermia induced by general anesthesia in facial plastic surgery. J Qilu Nursing. 2011;17(20):104–5.

    CAS  Google Scholar 

  66. Sun Y. Rescue and nursing of a patient with rare congenital multiarticular contracture and scoliosis complicated with malignant hyperthermia during operation. Chin General Practice Nursing. 2016;14(33):3561–2.

    Google Scholar 

  67. Tang Y, Wang R. Nursing care of a patient with malignant hyperthermia successfully rescued during an operation. Chin J Practical Nursing. 2004;20(3):47.

    CAS  Google Scholar 

  68. Tang Z, Wang Y, Guo X. Gu X: diagnosis and treatment of malignant hyperthermia after general anesthesia for cleft lip. West China Journal of Stomatology. 1996;14(1):41–4.

  69. Tao T, Tian K, Zhang C, Ding H, Hou X, Zhang J, et al. Successful treatment of one case of malignant hyperthermia during cervical discectomy and fusion. Chin J Anesthesiology. 2018;38(12):1535–6.

  70. Tian G, Xu K, Gu J, Tao G. Successful treatment of malignant hyperthermia: a case report. J Third Military Med University. 2014;36(12):1290,1298.

    Google Scholar 

  71. Wan J. The nursing experience of a patient with sudden malignant hyperthermia under general anesthesia. In: The 10th China Operating Room Nursing Academic Exchange and Special Lecture Conference; 2006. p. 2.

    Google Scholar 

  72. Wan X, Wu J. A case of intraoperative malignant hyperthermia. J Clin Anesth. 2012;28(11):1144.

    Google Scholar 

  73. Wang B, Shen J. Two cases from one family complicated with malignant hyperthermia during general anesthesia. Chin J Postgraduates of Med. 2018;41(8):757–9.

    Google Scholar 

  74. Wang C, Ye X, Shi X. Early diagnosis of malignant hyperthermia and treatment in the absence of dantrolene. Acad J Second Mil Univ. 2009;30(04):369–72.

    Article  Google Scholar 

  75. Wang L, He M, Wang J. Autopsy of malignant hyperthermia case. Chin J Clin Experimental Pathology. 2015;31(10):1196–7.

    Google Scholar 

  76. Wang M, Zhang H, Sun S. A case of intraoperative malignant hyperthermia. J Clin Anesth. 2006;22(6):439.

    Google Scholar 

  77. Wang S. A case of malignant hyperthermia during general anesthesia of branchial cleft cyst. J Community Med. 2009;7(9):84–5.

    Google Scholar 

  78. Wang T, Qin Z. A death case of malignant hyperthermia caused by a combination of halothane and succinylcholine chloride. Adverse Drug Reactions Journal. 2015;17(2):159–60.

    Google Scholar 

  79. Wang W. Malignant hyperthermia in 3 cases of cleft lip during and after general anesthesia. Curr Phys. 1998;3(3):61.

    Google Scholar 

  80. Wang X, Cheng L, Shi Y, Wang L. A case report of malignant hyperthermia. Chin J Bone Tumor Bone Dis. 2010;9(6):565–6.

    Google Scholar 

  81. Wang X, Lu Y, Qiu Y, Wu L. Diagnosis and treatment of malignant hyperthermia in children with congenital scoliosis. Int J Anesthesiology Resuscitation. 2016;37(1):46–8.

    Google Scholar 

  82. Wang Y. A death case of malignant hyperthermia during operation. Shanxi Clinical Med J. 1998;7(7):416–7.

    Google Scholar 

  83. Wang Y, Xiong L, Cai H. A case of malignant hyperthermia in general anesthesia. J Central South University (Medical Sciences). 2006;31(4):613–4.

    Google Scholar 

  84. Wang Z, Yu W, Lu Z, Li X. Gene expression characteristics of two patients with suspected malignant hyperthermia. Chin J Anesthesiology. 2003;23(11):875–6.

    Google Scholar 

  85. Wei J, Zhang J, Liang Z. A death case of suspected malignant hyperthermia during general anesthesia. J Clin Anesth. 2010;26(10):919.

    Google Scholar 

  86. Wu L, Ni S. Treatment of 1 case of anesthetic-induced malignant hyperthermia and literature analysis. China Pharmacy. 2012;23(38):3623–5.

    Google Scholar 

  87. Wu Q, Deng J. Nursing in ICU of a patient with malignant hyperthermia in scoliosis surgery. Chin General Pract Nursing. 2019;17(4):506–10.

    Google Scholar 

  88. Wu Q, Fang Y, Ran X, Fang H, Li Y, Mei W. Experience of successful treatment of a patient with malignant hyperthermia. Perioperative Safety Quality Assurance. 2017;1(5):250–3.

    Google Scholar 

  89. Wu R, Li H, Liu J, Li M. A case of malignant hyperthermia in general anesthesia. J Logistics University of CAPF. 2014;23(11):960–1.

    Google Scholar 

  90. Xiao J, Gu M, Qin Z, Chen Z, Liang S, Ouyang M, et al. Successful rescue of malignant hyperthermia during operation: a case report. J Clin Anesth. 2010;26(6):551.

  91. Xiao J, Gu M, Qin Z, Chen Z, Liang S, Ouyang M, et al. Changes of plasma protease in a patient with malignant hyperthermia and successful rescue: a case report. Guangdong Med J. 2010;31(8):1076.

  92. Xin Q, Xu M. The nursing experience of a child with malignant hyperthermia complicated with rhabdomyolysis syndrome. Laboratory Med Clinic. 2016;13(SupplementII):412–3.

    Google Scholar 

  93. Xiong J. Emergency treatment and nursing of a patient with malignant hyperthermia caused by anesthesia combined with multiple organ failure. Nanfang J Nursing. 2004;11(12):61.

    Google Scholar 

  94. Xu H, Jiang H, Huang H, Zhu Y. Emergency treatment of malignant hyperthermia during oral and maxillofacial surgery: two cases report. China J Oral Maxillofacial Surgery. 2007;5(5):386–8.

    Google Scholar 

  95. Xu P, Ge M, Gu Q. Successful rescue of intraoperative malignant hyperthermia combined with multiple organs dysfunction: a case report. Forum of Anesthesia and Monitoring. 2004;11(6):443–4.

    Google Scholar 

  96. Xue D, Sun L, Zhang K. Nursing cooperation of one case of suspected malignant hyperthermia after anesthesia induction. Chin J Medical Devices. 2013;28(04):132–3.

    Google Scholar 

  97. Yang M, Yang J. Rescue and nursing of a child with malignant hyperthermia during spinal orthopedic operation. World Latest Medicine Information. 2016;16(26):197–8.

    Google Scholar 

  98. Yang Y. The nursing experience of a patient with malignant hyperthermia during orthognathic operation. In: Chinese oral care academia exchange and special lecture conference, vol. 2004; 2004. p. 4.

    Google Scholar 

  99. Yao H. Experience of nursing cooperation in the successful rescue of a patient with malignant hyperthermia. In: The 10th China Operating Room Nursing Academic Exchange and Special Lecture Conference; 2006. p. 737–8.

    Google Scholar 

  100. Ye Y, Peng P, Yang Y. The nursing experience of the successful rescue of a patient with sudden malignant hyperthermia during general anesthesia. Nursing J Chinese People's Liberation Army. 2004;21(11):90–1.

    Google Scholar 

  101. Yu Y. Nursing report of emergency treatment in ICU for a patient with malignant hyperthermia. Modern Hospital. 2009;9(9):77–8.

    Google Scholar 

  102. Zeng J, Li L, Wang Z. Treatment of a case of intraoperative malignant hyperthermia. Lingnan Modern Clinics in Surgery. 2015;15(2):181–4.

    Google Scholar 

  103. Zeng R, Zhang J, Xue J, Liu J. A case of death caused by malignant hyperthermia in anesthesia. J Henan Med University. 1997;32(4):127.

    Google Scholar 

  104. Zhang A, Dong Q. Delayed malignant hyperthermia after general anesthesia: a case report. J North China Coal Medical Univ. 2002;4(1):97.

    Google Scholar 

  105. Zhang C, Zhang Y, Wang M, Wang Z, Zhang A. Role of operating room nurses in the rescue of rare malignant hyperthermia during operation. Med Pharmacy Yunnan. 2017;38(6):651–3.

    CAS  Google Scholar 

  106. Zhang H, Xie H, Yan X. One death case of malignant hyperthermia after general anesthesia. J Forensic Med. 2008;24(4):313–4.

    Google Scholar 

  107. Zhang L, Shen H, Chen S. A case report of malignant hyperthermia caused by anesthesia. Hainan Med J. 2008;19(1):136–7.

    Google Scholar 

  108. Zhang S: Nursing care of a patient with malignant hyperthermia. In: Chinese medicine nursing work experience academic exchange conference: 2002; 2002: 203–204.

  109. Zhang X. Experience in successfully treating a child with malignant hyperthermia. Med Inf. 2015;28(12):259.

    Google Scholar 

  110. Zhang X, Huang Y, Ge Z, Xu Z, Guo X, Luo A. Clinical diagnosis and management of malignant hyperthermia. Chin J Anesthesiology. 2000;20(8):454–5.

    Google Scholar 

  111. Zhang X, Yang B, Wang W, Long X, Mo Z. A neonatal case of malignant hyperthermia after anesthesia. Chin J Pediatr Surg. 2003;24(4):365.

    Google Scholar 

  112. Zhang Y, Yu J. Pathological analysis of a death case caused by malignant hyperthermia. Modern Practical Med. 2012;24(8):887–8.

    Google Scholar 

  113. Zhang Z, Gao Y, Gan X, Wang L, Wang Y. Strabismus surgery and malignant hyperthermia in children. Chin J Strabismus Pediatric Ophthalmology. 2013;21(4):10–1.

    Google Scholar 

  114. Zhao A, Li Y. The nursing experience of a patient with malignant hyperthermia during operation. Henan J Diagnosis Therapy. 2002;16(6):454–5.

    Google Scholar 

  115. Zheng M, Xu F, Xu J, Zhang Y, Jin L. A case of malignant hyperthermia successfully treated. Chin J Anesthesiology. 2005;25(4):248.

    Google Scholar 

  116. Zheng Y, Li C. Successful rescue of malignant hyperthermia during operation: a case report. Zhejiang Clin Med. 2018;20(3):563–4.

    Google Scholar 

  117. Zhou L, Zhao L, Wang J, Xu M, Pu X. Rescue and management of a rare patient with malignant hyperthermia during operation. J Nurses Training. 2002;17(12):949–50.

    Google Scholar 

  118. Zhou Y. Beware of malignant hyperthermia induced by anesthesia in cleft lip and palate operation. China Health care and Nutrition. 2014;4:1966–7.

    Google Scholar 

  119. Zhu G. Rescue and intensive care of a case of malignant hyperthermia during left cryptorchidism exploration. J Clinic Nursing's Practicality. 2017;2(49):160–1.

    Google Scholar 

  120. Zhu Y, Jiang H, Xu H, Liu H, Chen Z, Huang H. Successful resuscitation of malignant hyperthermia: two cases report. Shanghai Medical Journal. 2005;28(11):986–7.

    Google Scholar 

  121. Zuo J. A case report of successful treatment of malignant hyperthermia. Med Inf. 2013;26(11):208–9.

    Google Scholar 

  122. Carpenter D, Robinson RL, Quinnell RJ, Ringrose C, Hogg M, Casson F, et al. Genetic variation in RYR1 and malignant hyperthermia phenotypes. Br J Anesth. 2009;103(4):538–48. https://doi.org/10.1093/bja/aep204.

  123. Larach MG, Gronert GA, Allen GC, Brandom BW, Lehman EB. Clinical presentation, treatment, and complications of malignant hyperthermia in North America from 1987 to 2006. Anesth Analg. 2010;110(2):498–507. https://doi.org/10.1213/ANE.0b013e3181c6b9b2.

    Article  PubMed  Google Scholar 

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  1. Department of Cardiology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité University Medicine, Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany

    Xiaodan Gong

  2. Department of Anesthesiology, The Second Clinical Medical College, Yangtze University, Jingzhou, 434020, China

    Xiaodan Gong

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Supplemental Figure S1. Flow chart of the study selection procedure. MH, malignant hyperthermia.

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Supplemental Table S1. The use of vasoactive agents of Malignant hyperthermia cases.

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Gong, X. Malignant hyperthermia when dantrolene is not readily available. BMC Anesthesiol 21, 119 (2021). https://doi.org/10.1186/s12871-021-01328-3

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