Sir, malignant hyperthermia is a rare but often fatal genetic skeletal muscle disorder.1,2 It is characterised by an abnormality in muscle metabolism upon exposure to volatile anaesthetic agents, extreme heat or stress.3,4
The disease has major implications for dentistry and clinicians have a responsibility to screen patients for the disorder. A thorough patient medical history and family history and in particular, anaesthetic history must be assessed.3,4 Muscle disorders such as scoliosis and myotonia congenita are often associated with malignant hyperthermia and thus, follow up investigations should be performed to rule out the disorder before considering GA for these patients.3,4 A history of a fever of unknown origin, a family history of reactions or unexplained death during anaesthesia should be investigated further before providing GA to the patient.3,4 In addition, dentistry can trigger stress, anxiety and pain which can also lead to a malignant hyperthermic episode.2,3 It is essential that dentistry is provided to these patients in the most comfortable, safe and effective manner.
As aforementioned, volatile anaesthetic agents can trigger a malignant hyperthermic episode.1,4 In the past, local anaesthetics were considered triggers, however now, local anaesthetics have been considered safe to use. In addition, nitrous oxide sedation and benzodiazepines have not been deemed as triggers for malignant hyperthermia. As mentioned previously, stress can trigger an episode therefore it is essential that a clinician explores all non-pharmacological and pharmacological techniques when providing care for these patients.
References
Cornelius B W, Dib S O, Dowdy R A et al. Malignant hyperthermia: a case study in the dental ambulatory surgery setting. Anesth Prog 2019; 66: 202-210.
Adriani J, Sundin R. Malignant hyperthermia in dental patients. J Am Dent Assoc 1984; 108: 180-184.
Reifenstahl E F, Rowshan H H. Malignant hyperthermia and its implications in general dentistry. Gen Dent 2009; 57: 242-246.
Riazi S, Kraeva N, Hopkins P M. Updated guide for the management of malignant hyperthermia. Can J Anaesth 2018; 65: 709-721.
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Quearney, J. Malignant hyperthermia - rare but fatal. Br Dent J 234, 136 (2023). https://doi.org/10.1038/s41415-023-5564-8
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DOI: https://doi.org/10.1038/s41415-023-5564-8