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ANZCA and FPM CPD Program resources: Malignant hyperthermia

Activity: Malignant hypothermia Emergency response

Guide index

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Category 1: Practice evaluation

Category 2: Knowledge & skills

Category 3: Emergency response

Malignant hyperthermia

Simulation activity which aims to ensure anaesthetists and pain medicine specialists have recognised training to recognise and manage malignant hyperthermia.

Participate in a malignant hyperthermia-related activity - find recognised courses and workshops on the college website.

CPD Value: CPD participants may claim this under Emergency response Malignant hyperthermia activity.

Recognised algorithms and guidelines

ANZCA recognises that several published algorithms exist for the treatment of malignant hyperthermia. Malignant Hyperthermia Australia and New Zealand (MHANZ) has published algorithms, which closely align with the algorithms published by the European Malignant Hyperthermia Group (EMHG) and the Association of Anaesthetists of Great Britain and Ireland (AAGBI) (see recommended readings), should be used for Malignant Hyperthermia treatment.

Malignant Hyperthermia Australia and New Zealand (MHANZ)
Malignant hyperthermia (MH) or malignant hyperpyrexia is a rare life-threatening condition that is triggered by exposure to certain drugs used for general anaesthesia - specifically the volatile anaesthetic agents and suxamethonium, a neuromuscular blocking agent.
Malignant Hyperthermia Resource Kit
Developed by Malignant Hyperthermia Australia and New Zealand.
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Malignant Hyperthermia (MH) is a rare pharmacogenetic disorder. MH reactions are potentially fatal if prompt appropriate treatment is not instituted. An MH crisis is increasingly rare and many anaesthetists will not experience one in their practising career. There are many high priority tasks that must be attended to simultaneously. For these reasons, the group of anaesthetists responsible for MH investigation in Australia and New Zealand (mhanz) have completed the attached MH Resource Kit. In some cases the recommendations represent re-worked or refined versions of pre-existing documents. The mhanz group acknowledges the staff of Palmerston North Hospital (New Zealand) and the Southern Health Simulation Centre (Victoria) for their contribution to our final package.

Recommended readings

Hopkins PM, Girard T, Dalay S, et al. Malignant hyperthermia 2020: Guideline from the Association of Anaesthetists. Anaesthesia. 2021;76(5):655-664. Keywords: activated charcoal filters; dantrolene; malignant hyperthermia: associated disorders; malignant hyperthermia: peri-operative management; malignant hyperthermia: signs.
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Abstract
Malignant hyperthermia is defined in the International Classification of Diseases as a progressive life-threatening hyperthermic reaction occurring during general anaesthesia. Malignant hyperthermia has an underlying genetic basis, and genetically susceptible individuals are at risk of developing malignant hyperthermia if they are exposed to any of the potent inhalational anaesthetics or suxamethonium. It can also be described as a malignant hypermetabolic syndrome. There are no specific clinical features of malignant hyperthermia and the condition may prove fatal unless it is recognised in its early stages and treatment is promptly and aggressively implemented. The Association of Anaesthetists has previously produced crisis management guidelines intended to be displayed in all anaesthetic rooms as an aide memoire should a malignant hyperthermia reaction occur. The last iteration was produced in 2011 and since then there have been some developments requiring an update. In these guidelines we will provide background information that has been used in updating the crisis management recommendations but will also provide more detailed guidance on the clinical diagnosis of malignant hyperthermia. The scope of these guidelines is extended to include practical guidance for anaesthetists dealing with a case of suspected malignant hyperthermia once the acute reaction has been reversed. This includes information on care and monitoring during and after the event; appropriate equipment and resuscitative measures within the operating theatre and ICU; the importance of communication and teamwork; guidance on counselling of the patient and their family; and how to make a referral of the patient for confirmation of the diagnosis. We also review which patients presenting for surgery may be at increased risk of developing malignant hyperthermia under anaesthesia and what precautions should be taken during the peri-operative management of the patients.
Glahn KP, Ellis FR, Halsall PJ, et al. Recognizing and managing a malignant hyperthermia crisis: guidelines from the European Malignant Hyperthermia Group. Br J Anaesth. 2010;105(4):417-420.
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Abstract
Survival from a malignant hyperthermia (MH) crisis is highly dependent on early recognition and prompt action. MH crises are very rare and an increasing use of total i.v. anaesthesia is likely to make it even rarer, leading to the potential risk of reduced awareness of MH. In addition, dantrolene, the cornerstone of successful MH treatment, is unavailable in large areas around the world thereby increasing the risk of MH fatalities in these areas. The European Malignant Hyperthermia Group collected and reviewed all guidelines available from the various MH centres in order to provide a consensus document. The guidelines consist of two textboxes: Box 1 on recognizing MH and Box 2 on the treatment of an MH crisis.

ANZCA & FPM resources

CPD Activity Guide
This guide contains a list of all the activities associated with the ANZCA and FPM CPD Program, as well as links to associated individual activity guides and forms.
ANZCA and FPM CPD Program: Malignant hyperthermia ER session guideline
This guideline assists hospitals, private practice groups and other course providers develop and conduct Malignant hyperthermia Emergency Response (ER) sessions. It defines the learning objectives and other requirements for education providers to become recognised malignant hyperthermia ER providers for the purposes of the ANZCA and FPM CPD program.
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For CPD participants, this guideline provides information on what recognised Malignant Hyperthermia ER sessions involve and how to record this activity.
Malignant hyperthermia ER activity recognition of suitability application form
Course providers must apply for college recognition of your session as a suitable Malignant hyperthermia ER activity for the ANZCA and FPM CPD program. Providers are encouraged to develop sessions that also satisfy local needs, incorporating local staff, work environments and equipment.

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