If you or someone you know has to undergo surgery, you have probably heard the word anesthesia. It means that we are put to sleep during surgery. But have you ever thought that some people can have a very dangerous, even life-threatening reaction to these anesthetic drugs? That is one such rare, but very serious condition called Malignant Hyperthermia. The name may sound a little scary, but if you are properly informed about it, many problems can be avoided. So, let's talk about it in detail today.
What is Malignant Hyperthermia?
Simply put, `Malignant Hyperthermia` is a genetic condition . That is, it is caused by a mutation in our genes. When a person with this condition is given certain anesthesia medications, their body reacts very badly. This is an emergency that can even be life-threatening.
The best part is, although this is usually something that is passed down from generation to generation, there are treatments for it . And, if you know about this risk early, you can protect yourself from it.
We know that when we are given general anesthesia, we can feel nothing during surgery. There are various types of drugs to provide this anesthesia. However, only a very few of those drugs cause this condition called `Malignant Hyperthermia`. Most anesthetic drugs do not cause this.
Another important thing is that sometimes a person may not know they have the genetic mutation that can cause Malignant Hyperthermia, because they may not show any symptoms until they are exposed to the specific drugs mentioned.
Who is more likely to develop this?
Let's see who is at higher risk of developing this `Malignant Hyperthermia` condition.
Essentially, if someone in your family has had a previous case of `Malignant Hyperthermia` , then other members of that family may also be at risk. In particular, if a first-degree relative (i.e. mother, father, siblings, children) has had the condition, you are considered to be `susceptible`.
Therefore, if you ever have to have surgery, it is very important to inform the anesthesiologist if anything like this has happened to anyone in your family.
Imagine, let's say your family has never had a `Malignant Hyperthermia` reaction like this. However, people with certain muscle diseases may also be at increased risk. Some of these diseases are:
- `Central core disease`
- `Multiminicore disease`
- `King-Denborough syndrome`
- `STAC3 disorder`
Although this may seem a bit complicated, it is good for those with these conditions to be aware of this.
How common is this condition?
How common is this `Malignant Hyperthermia`? Although statistics are a bit mixed, it is generally estimated that this condition can occur in about one in 100,000 surgeries in adults. Among children, this number is about one in 30,000 surgeries. It is also noteworthy that half of the patients identified are under the age of 19.
But scientists think that people who are predisposed to this `Malignant Hyperthermia` condition may be more likely to be in society. Because many people are not exposed to the specific drugs that cause it throughout their lives, they may not even know they are at risk.
What are the symptoms of this?
The symptoms of `Malignant Hyperthermia` can vary slightly from person to person. They can appear during surgery or while you are recovering from surgery. For example, if you are under anesthesia and these symptoms appear during surgery, you will not feel it. However, your anesthesiologist or anesthesia nurse is very vigilant about this. They monitor everyone who is under anesthesia very carefully. As soon as they notice these symptoms, they will immediately start treatment for `Malignant Hyperthermia`.
Early signs
These are the first signs you may notice:
- Unexplained increase in heart rate (tachycardia). The heart rate suddenly increases.
- A sudden increase in the amount of carbon dioxide exhaled from the body . This can also be treated with medical equipment.
- Increased breathing rate (tachypnea). You start breathing rapidly, as if you are gasping for breath.
- Muscle stiffness, stiffness (`muscle rigidity`). The muscles in the body become stiff as if they were being crushed by a rock.
- Sudden increase in body temperature . The body starts to heat up.
Symptoms that appear later
As the situation worsens, you may also see symptoms like:
- A rise in body temperature above a normal fever .
- Dark urine . It may even turn brown.
- Blood tests showing muscle breakdown .
- Heart rhythm irregularities (arrhythmia). The heart beats abnormally.
- Bleeding .
- Conditions such as seizures .
Why does malignant hyperthermia occur?
Now let's see why this condition called `Malignant Hyperthermia` occurs.
People with this condition have an abnormal protein in their muscle cells. This is due to a change in their genes, called a genetic mutation .
Simply put, our DNA is like an "instruction book" that contains the information the cells in our body need to do their jobs. If there is a bit of information missing somewhere in this DNA, or if there is damage to something, that's when genetic diseases like these occur.
This genetic mutation does not cause any symptoms in normal life. However, if a person with this mutation is exposed to the specific anesthetic drugs mentioned above – or, very rarely, if exposed to high temperatures or if they engage in strenuous exercise – their muscle cells begin to release calcium abnormally.
As a result, the muscles continue to contract and become tense or rigid, the body's metabolism and body temperature increase abnormally. Eventually, the muscle cells die, and large amounts of potassium accumulate in the blood. This can lead to further symptoms and complications.
Anesthetic drugs can cause this condition.
A person who is genetically predisposed to the condition `Malignant Hyperthermia` may experience this reaction if they are given the following anesthetic drugs:
Inhaled medications:
- `Halothane`
- `Desflurane`
- `Sevoflurane`
- `Isoflurane`
Intravenous medications:
- Succinylcholine – This is a fast-acting muscle relaxant.
How do you recognize this?
If you have surgery using a dangerous anesthetic without knowing that you have a predisposition to `Malignant Hyperthermia`, neither you nor the anesthesiologist will know that you have it until after the reaction occurs.
However, when you or someone else is given anesthesia, the anesthesiologist or nurse will monitor your vital signs and health very closely during and after the surgery. If you have `Malignant Hyperthermia`, they will recognize it by the abnormal vital signs and reactions mentioned earlier. That is:
- Increased heart rate for no reason.
- Rapid rise in body temperature.
- A sudden increase in the amount of carbon dioxide exhaled from the body.
- Muscle tightness.
Anesthesiologists are trained to recognize these changes early . Then they can respond quickly to this emergency. The faster the diagnosis, the more treatment and control the condition can be achieved.
How do you know in advance if you have this risk?
If you or your doctor think you may be at risk for Malignant Hyperthermia, whether because of your family history or for other reasons, there are some special tests that can be done to confirm this:
- Caffeine halothane contracture test (CHCT) : For this test, a small piece of your muscle (muscle biopsy) is taken and the tissue sample is exposed to solutions of halothane and caffeine to see if it responds to an anesthetic gas.
- Genetic testing : These tests can identify mutations in the genes in the DNA called RYR1, STAC3, and CACNA1S. More than 45 mutations have been identified that can cause Malignant Hyperthermia.
However, these tests to detect a predisposition to `Malignant Hyperthermia` are quite expensive , and they can only be performed in a few specialized laboratories. For example, the `CHCT` test is only available in four locations in the United States. Therefore, if you need to have emergency surgery and a close relative has previously had `Malignant Hyperthermia`, anesthesiologists usually use safer anesthetics instead of those risky drugs.
What are the treatments for this?
The main treatment for malignant hyperthermia is the drug dantrolene (brand name Dantrium®).
As soon as anesthesiologists suspect a condition called `Malignant Hyperthermia`, they administer this `dantrolene` drug. At the same time, they stop administering the anesthetic drug that caused the reaction, and the surgeon completes the surgery as quickly as possible.
In addition, the anesthesia and surgical team also treats other symptoms and complications caused by `Malignant Hyperthermia`. Some of these treatments are:
- Hyperthermia is treated with cooling methods , such as giving cold IV fluids and applying ice packs.
- Oxygen is given either through a face mask or a tube placed in the trachea.
- If there is an irregular heartbeat (arrhythmia), medication is given for it.
Once your condition has stabilized, you will be kept in the intensive care unit (ICU) for at least a day for observation . The medical team will perform further tests (e.g. blood tests) and provide further treatment if necessary.
Can this be prevented?
Malignant Hyperthermia is a bit harder to prevent, unless you know you have the genetic mutation that causes it , or someone in your family has the condition and you've told your anesthesiologist. In that case, the anesthesiologist won't use those risky drugs in your anesthesia plan.
But, the sad thing is, most of the time people only find out they are at risk for Malignant Hyperthermia after it happens to them.
What happens after this condition? Can it be cured?
If the symptoms of `Malignant Hyperthermia` are recognized early and treated properly, a full recovery is possible . The prompt action of the anesthesia and surgical team is very important here.
However, we must also remember that sometimes, even with prompt treatment, multiple organ failure and even death can occur.
What other complications can occur due to malignant hyperthermia?
Malignant Hyperthermia can cause serious complications such as:
- Muscle damage
- Kidney failure
- Liver failure
- Bleeding
- Cardiac arrest
- Seizures
- Coma
- Death
Is this fatal?
If left untreated, `Malignant Hyperthermia` is a potentially fatal condition . Even with proper treatment, the reported mortality rate is between 3% and 5%. Therefore, this is not something to be taken lightly.
When should I see a doctor about this?
If you are preparing for surgery, it is very important to tell the doctors if anyone in your family has had any previous problems with anesthesia .
Also, if you are newly diagnosed with a genetic mutation that causes Malignant Hyperthermia in a blood relative (biological relative), or if you learn that that person has developed a condition called Malignant Hyperthermia, it is very important to inform your doctor and make a note of this in your medical records.
The most important things you need to remember in this article
Malignant Hyperthermia is a serious, life-threatening reaction to certain anesthetic drugs.
The good news is that it can be treated and, if you know you are at risk, it can be prevented.
If possible, know all the details about the medical history of your blood relatives. Share that information with your doctor. Since `Malignant Hyperthermia` is caused by a genetic mutation that is passed down through generations, if someone in your family has it, you are also at higher risk.
If you have any questions or concerns about surgery and the anesthesia you will receive, never hesitate to ask your doctor. They are there to help you. Your awareness and open communication with your medical team are the best protection for you.
` malignant hyperthermia, anesthesia, surgery, genetic diseases, family history, anesthesia complications, high body temperature
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