One of the causes of death on the operating table is a rare disease, "Malignant hyperthermia." At the heart of this disease are metabolic disorders in muscle tissue that appear as a result of general anesthesia. Its symptoms are shortness of breath, fever and palpitations, which can be fatal.
Malignant hyperthermia is a hereditary disease. It does not manifest itself until the moment when a person receives a dose of anesthesia. Even the fact that the parents did not manifest the disease in any way, if they were anesthetized, does not mean at all that they are not the carrier of the gene that the children passed on and will manifest in them.
This disease does not appear out of nowhere. Its development requires a genetic predisposition or neuromuscular disease. A very serious signal for doctors should be that one of the patient’s relatives who should be anesthetized died during anesthesia, as it is likely that it was death precisely from malignant hyperthermia. If you have an operation, you need to ask relatives about whether there were any people in your family who were ill during anesthesia, and even more so if someone died during the operation. If such cases were, you should inform your doctor.
In addition, malignant hyperthermia can occur in patients suffering from Becker muscular dystrophy, Duchenne muscular dystrophy, as well as some other neuromuscular diseases.
Malignant hyperthermia is not treated. The only effective medication that helps save a patient who showed signs of the disease during anesthesia is dantrolene. In the United States, for example, there is a ban on administering anesthesia if, for some reason, dantrolene is not available in the hospital. However, in Russia this drug is not registered, and therefore not for sale.
Since the only cure for malignant hyperthermia is prohibited in Russia, the only thing left is to prevent this disease. If your family has had cases associated with intolerance to anesthesia, or you have a neuromuscular disease, you should definitely notify your doctor about this. If you have surgery, then there is every chance that malignant hyperthermia will appear during anesthesia. In oncology, an operation or, let's say, ordinary appendicitis is ahead, it does not matter.
If a patient with a predisposition to this disease gets onto the operating table, the doctor (and the patient himself, too) should definitely pay attention to such points:
- for anesthesia of such patients it is strictly forbidden to use such drugs as muscle relaxant dithilin and inhaled antiseptics. The remaining drugs for anesthesia are practically safe for malignant hyperthermia;
- before starting the patient to be anesthetized, the evaporator should be removed from the anesthesia-respiratory apparatus (this is the container into which the inhaled anesthetic is poured);
- the hose system through which the patient is given a breathing mixture must be replaced with a new one;
- before connecting the anesthesia-respiratory apparatus to the patient , you should keep it switched on “idle” for about half an hour. These steps are necessary in order to clean the device of inhalation anesthetics that were used during the previous operation.
All of these measures will help reduce the risk for patients who could theoretically be at risk of malignant hyperthermia. Treatment of this serious complication of anesthesia in our country is impossible.
Unfortunately, in Russia there is no statistics on cases of manifestations of malignant hyperthermia. However, there are such statistics in the USA, and it is disappointing: approximately 200 cases a year. Based on data on the population, in Russia there should be about 100 such cases. In the United States, malignant hyperthermia is treated with dantrolene, which significantly reduces the mortality rate from this disease. But in Russia this drug is not, and if a person has an attack during anesthesia, the chances of salvation are minimal.