Hellblom Anna, Miller William Pettersson, Soller Maria, Samuelsson Carolina
Department of Intensive and Perioperative Care, Skåne University Hospital, Lund, Sweden.
Department of Laboratory Medicine, Clinical Genetics, Lund University, Lund, Sweden.
Acta Anaesthesiol Scand. 2024 Jul;68(6):788-793. doi: 10.1111/aas.14417. Epub 2024 Apr 2.
Malignant hyperthermia (MH) is a rare pharmacogenetic disorder that can lead to a life-threatening reaction during general anaesthesia with triggering agents. Prompt life-saving treatment includes the immediate administration of the antidote dantrolene. This study investigated Swedish healthcare providers' awareness and adherence to guidelines and recommendations with respect to MH and whether adherence to safe MH-praxis varies with hospital care-complexity level and private versus public management form.
Agreements and procurement specifications between all 21 Swedish County Councils and privately run surgical care providers were reviewed alongside with questionnaire-aided collection of information from 62 publicly funded health care providers (both privately and publicly run).
No procurement requirement specification or contract contained requirements on anaesthesia or aspects of MH. All publicly run hospitals stocked dantrolene and 28 out of 52 (54%) stocked the recommended amount. Seven out of nine (78%) of the privately run institutions stocked dantrolene, and one stocked the recommended amount. Publicly run hospitals adhered to recommendations to a greater extent than privately run institutions, both with respect to stocking of dantrolene (p = .02) and to stocking the recommended amount (p = .03).
Contracts between Swedish county councils and private surgical care subcontractors rarely outline expectations of standards for the safe practice of anaesthesia such as preparedness to handle a life-threatening MH reaction. Among Swedish publicly funded anaesthesia providers there is room for improvement in adherence to the EMHG guideline on dantrolene availability. Publicly run hospitals seem to have better compliance with these recommendations than privately run institutions. Raising awareness about current guidelines is important to improve safety for known and unknown MH-susceptible individuals.
恶性高热（MH）是一种罕见的药物遗传疾病，在使用触发剂进行全身麻醉期间可导致危及生命的反应。及时的挽救生命治疗包括立即给予解毒剂丹曲林。本研究调查了瑞典医疗服务提供者对MH指南和建议的认知及遵循情况，以及遵循安全的MH实践是否因医院护理复杂程度和私立与公立管理形式而异。
审查了瑞典所有21个郡议会与私立外科护理提供者之间的协议和采购规范，并通过问卷调查从62家公共资助的医疗服务提供者（包括私立和公立）收集信息。
没有采购要求规范或合同包含对麻醉或MH方面的要求。所有公立医院都储备了丹曲林，52家中有28家（54%）储备了推荐量。9家私立机构中有7家（78%）储备了丹曲林，1家储备了推荐量。在丹曲林储备方面（p = 0.02）以及储备推荐量方面（p = 0.03），公立医院比私立机构在更大程度上遵循了建议。
瑞典郡议会与私立外科护理分包商之间的合同很少概述对安全麻醉实践标准的期望，例如应对危及生命的MH反应的准备情况。在瑞典公共资助的麻醉提供者中，在遵循关于丹曲林可用性的欧洲恶性高热组（EMHG）指南方面仍有改进空间。公立医院似乎比私立机构更好地遵守了这些建议。提高对现行指南的认识对于提高已知和未知MH易感个体的安全性很重要。
