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.
Anesth Analg. 2019 Apr;128(4):652-659. doi: 10.1213/ANE.0000000000004039.
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.
在美国最近的一次共识会议上，恶性高热协会（Malignant Hyperthermia Association of the United States）针对恶性高热易感性或急性恶性高热患者的最佳管理，提出了 6 个重要且尚未解决的临床问题。其中包括：（1）在无法使用挥发性麻醉剂或仅将琥珀酰胆碱储存于现场以备紧急使用的场所，应储备多少量的丹曲林？（2）如何定义咬肌僵硬？它与恶性高热有何关系，发生时应如何处理？（3）恶性高热易感性与热或运动相关的横纹肌溶解之间有何关系？（4）应推荐哪些基于证据的干预措施来缓解与恶性高热相关的高热？（5）在治疗急性恶性高热后，应给予多少丹曲林，治疗多长时间？应使用什么标准来确定停止丹曲林治疗？（6）在进行诊断性检查之前，有疑似个人或家族恶性高热病史的患者可以安全地接受麻醉吗？本报告描述了对上述每个未解答临床问题的共识过程和结果。
