University Witten/Herdecke, Department of Anaesthesiology and Intensive Care Medicine, Department of Paediatric Anaesthesia, Clinics of Cologne, Cologne, Germany.
Curr Opin Anaesthesiol. 2010 Jun;23(3):417-22. doi: 10.1097/ACO.0b013e328337ffe0.
Malignant hyperthermia-susceptible patients have an increased risk during anaesthesia. The aim of this review is to present current knowledge about pathophysiology and triggers of malignant hyperthermia as well as concepts for safe anaesthesiological management of these patients.
Trigger substances and mechanisms have been well defined to date. Anaesthesia can be safely performed with i.v. anaesthetics, nitrous oxide, nondepolarizing muscle relaxants, local anaesthetics as well as xenon. Attention must be directed to the preparation of the anaesthetic machine because modern workstations need longer cleansing times than their predecessors. Alternatively, activated charcoal might be beneficial for elimination of volatile anaesthetics. Day case surgery can be performed in malignant hyperthermia-susceptible patients, if all safety aspects are regarded. Whether there is an association between malignant hyperthermia susceptibility and other disorders is still a matter of debate.
The incidence of malignant hyperthermia is low, but the prevalence can be estimated as up to 1: 3000. Because malignant hyperthermia is potentially lethal, it is relevant to establish management concepts for perioperative care in susceptible patients. This includes preoperative genetic and in-vitro contracture testing, preparation of the anaesthetic workstation, use of nontriggering anaesthetics, adequate monitoring, availability of sufficient quantities of dantrolene and appropriate postoperative care. Taking these items into account, anaesthesia can be safely performed in susceptible patients.
恶性高热易感患者在麻醉期间风险增加。本文旨在介绍恶性高热的病理生理学和触发因素的最新知识，以及这些患者安全麻醉管理的概念。
迄今为止，已经很好地定义了触发物质和机制。可以安全地使用静脉内麻醉剂、一氧化二氮、非去极化肌松剂、局部麻醉剂以及氙气进行麻醉。必须注意麻醉机的准备，因为现代工作站需要比其前身更长的清洁时间。或者，活性炭可能有利于挥发性麻醉剂的消除。如果考虑到所有的安全方面，日间手术可以在恶性高热易感患者中进行。恶性高热易感性与其他疾病之间是否存在关联仍存在争议。
恶性高热的发病率较低，但患病率估计高达 1:3000。由于恶性高热具有潜在致命性，因此建立易感患者围手术期管理概念非常重要。这包括术前基因和体外收缩试验、麻醉工作站的准备、非触发麻醉剂的使用、充分的监测、足够数量的丹曲林的可用性以及适当的术后护理。考虑到这些因素，麻醉可以在易感患者中安全进行。
