Skip to main content Accessibility help

Prospective management of malignant hyperthermia in the otolaryngological patient

  • Phillip Ashley Wackym (a1) and Imad H. Abdul-Rasool (a2)


Malignant hyperthermia (MH) is a seemingly rare genetic myopathy. Hypermetabolic crises accompanied by a rise in body temperature to as high as 44°C are its hallmark. These are usually triggered by potent inhalation anesthetics or depolarizing muscle relaxants. Because of the extraordinary risk of death in patients who are at risk, otolaryngologists may be reluctant to operate on these patients. Ten such patients undergoing tonsillectomy and adenoidectomy, myringotomy with ventilation tube insertion, and nasal polypectomy were anesthetized with nitrous oxide, barbiturates, opiates, tranquilizers and non-depolarizing muscle relaxants without complication. The patients were not treated prophylactically with dantrolene. Cardiac monitoring and rectal temperatures were followed. All ten patients had vastus lateralis muscle biopsy performed and subsequent caffeine/halothane contracture studies completed. The contracture study was positive in eight out of the patients studied. No anesthetic or surgical complications were encountered. This study demonstrates that patients at risk of developing MH crisis can have otolaryngologic procedures performed safely while undergoing appropriately selected general anesthesia.


Corresponding author

Imad H. Abdul-Rasool, M.D., Ph.D., Director, Malignant Hyperthermia Center, UCLA Hospital, Los Angeles, CA 90024, U.S.A.


Hide All
Britt, B. A. (1985) Malignant hyperthermia. Canadian Anaesthetists' Society Journal, 32: 666677.
Britt, B. A. and Kalow, W. (1970) Malignant hyperthermia: A statistical review. Canadian Anaesthetists' Journal, 17: 293315.
Britt, B. A., McComas, A. J., Endrenyi, L. and Kalow, W. (1977) Motor unit counting and the caffeine contracture test in malignant hyperthermia. Anesthesiology, 47: 490497.
Britt, B. A., Scott, E., Frodis, W., Clements, M. J. and Endrenyi, L. (1984) Dantrolene—in vitro studies in malignant hyperthermia susceptible (MHS) and normal skeletal muscle. Canadian Anaesthetists' Society Journal, 31: 130154.
Denborough, M. A. and Lovell, R. R. H. (1960) Anaesthetic deaths in a family (letter to the editor). Lancet, 2: 45.
Gallant, E. M. and Anhern, C. P. (1983) Malignant hyperthermia: Responses of skeletan muscle to general anesthetic. Mayo Clinic Proceedings, 58: 758763.
Gronert, G. A. (1980) Malignant hyperthermia. Anesthesiology, 53: 395423.
Gronert, G. A. (1986) Malignant hyperthermia, in Miller, R. D. (ed.), Anesthesia. New York, Churchill Livingstone, pp. 19711994.
Huckell, V. F., Staniloff, H. M., Britt, B. A., Waxman, M. B. and Morch, J. E. (1978) Cardiac manifestations of malignant hyperthermia susceptibility. Circulation, 58: 916925.
Jardon, O. M., Wingard, D. W., Barak, A. J. and Connolly, J. F. (1979) Malignant hyperthermia. A potentially fatal syndrome in orthopaedic patients. Journal of Bone and Joint Surgery, 61-A: 10641070.
Kalow, W., Britt, B. A. and Chan, F-Y (1979) Epidemiology and inheritance of malignant hyperthermia. International Anesthesiology Clinics, 17: 119140.
Pollock, R. A. and Britt, B. A. (1983) Malignant hyperthermia in the head and neck patient: An update and review. Laryngoscope, 93: 318325.
Ruhland, G. and Hinkle, A. J. (1984) Malignant hyperthermia after oral loading and intravenous pretreatment with dantrolene n i a patient susceptible to malignant hyperthermia. Anesthesiology, 60: 159160.
Watson, C. B., Reierson, N. and Norfelect, E. A. (1986) Clinically significant muscle weakness induced by oral dantrolene sodium prophylaxis for malignant hyperthermia. Anesthesiology, 65: 312314.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

The Journal of Laryngology & Otology
  • ISSN: 0022-2151
  • EISSN: 1748-5460
  • URL: /core/journals/journal-of-laryngology-and-otology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *


Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed