Chulalongkorn Medical Journal


Objective : To survey the clinical memorable experiences, which weresuggested to intraoperative malignant hyperthermia (MH) amongThai anesthesiologists.Material and Method : Questionnaires for a national survey of dantrolene requirement weresent by the Royal College of Thai Anesthesiologists (RCAT) to allThai anesthesiologists (855 members) in 2007. One hundred andtwo (11.93%) questionnaires were returned. There were 25anesthesiologists (24.51%), who had experiences of suspectedMH events. All of them were later included for an interview byphone. The questions consisted of which part of the regionthe hospital is located in, the number of MH events, clinicalmanifestations, problems in the diagnosis and management,the outcomes in terms of mortality and medico-legal aspect, andpreventive strategy for MH.Results : The most frequent clinical signs of MH were inappropriate sinustachycardia (100%), masseter spasm (84%), rapid increase in bodytemperature (64%), and generalized muscular rigidity (44%). Onlyhalf of the suspected MH patients were monitored with capnogram.About one-third (32%) of the patients received dantrolene. Acidosiswas corrected in nearly two-thirds (60%) of the suspected MHpatients. The mortality rate of MH was 36%. One anesthesiologist(4%) encountered litigation problem from a fatal case. Familycounseling was conducted in 84% of cases. Suggestions fromanesthesiologists, who experienced MH were expansion andpublicity of dantrolene-stored hospitals, and more educationprograms on MH.Conclusion : Although MH is a rare condition, it induces high mortality whichpotentially brings in the litigation. Earlier detection and shortenthe time until the initial dantrolene administration should be acquired.


Faculty of Medicine, Chulalongkorn University

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