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Consensus Statement of the Malignant Hyperthermia Association of the United States on Unresolved Clinical Questions Concerning the Management of Patients With Malignant Hyperthermia

Litman, Ronald S. DO, ML*,†; Smith, Victoria I.; Larach, Marilyn Green MD, FAAP§; Mayes, Lena MD; Shukry, Mohanad MD, PhD¶,#; Theroux, Mary C. MD**,††; Watt, Stacey MD, FASA‡‡; Wong, Cynthia A. MD§§

doi: 10.1213/ANE.0000000000004039
Anesthetic Clinical Pharmacology

At a recent consensus conference, the Malignant Hyperthermia Association of the United States addressed 6 important and unresolved clinical questions concerning the optimal management of patients with malignant hyperthermia (MH) susceptibility or acute MH. They include: (1) How much dantrolene should be available in facilities where volatile agents are not available or administered, and succinylcholine is only stocked on site for emergency purposes? (2) What defines masseter muscle rigidity? What is its relationship to MH, and how should it be managed when it occurs? (3) What is the relationship between MH susceptibility and heat- or exercise-related rhabdomyolysis? (4) What evidence-based interventions should be recommended to alleviate hyperthermia associated with MH? (5) After treatment of acute MH, how much dantrolene should be administered and for how long? What criteria should be used to determine stopping treatment with dantrolene? (6) Can patients with a suspected personal or family history of MH be safely anesthetized before diagnostic testing? This report describes the consensus process and the outcomes for each of the foregoing unanswered clinical questions.

From the *Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania

Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania

Department of Chemistry, Drexel University, Philadelphia, Pennsylvania

§The North American Malignant Hyperthermia Registry of the Malignant Hyperthermia Association of the United States at the Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida

Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado

Division of Pediatric Anesthesiology, Department of Anesthesiology, Children’s Hospital & Medical Center, Omaha, Nebraska

#University of Nebraska Medical Center, Omaha, Nebraska

**Department of Anesthesiology and Perioperative Medicine, Alfred I. duPont Hospital for Children, Wilmington, Delaware

††Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania

‡‡Department of Anesthesiology, University at Buffalo School of Medicine, Kaleida Health, Buffalo, New York

§§Department of Anesthesia, University of Iowa, Iowa City, Iowa.

Published ahead of print 20 December 2018.

Accepted for publication December 2, 2018.

Funding: Travel, hotel, and some food expenses for the attendees at the consensus meeting were paid by the Malignant Hyperthermia Association of the United States.

The authors declare no conflicts of interest.

Reprints will not be available from the authors.

Address correspondence to Ronald S. Litman, DO, ML, Department of Anesthesiology & Critical Care, The Children’s Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104. Address e-mail to

Copyright © 2019 International Anesthesia Research Society
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