Malignant hyperthermia 2020 Guideline from the Association of Anaesthetists
Malignant hyperthermia 2020 Guideline from the Association of Anaesthetists
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DOI：
10.1111/anae.15317
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发表时间：
2021-01-05
期刊：
影响因子：
10.7
通讯作者：
McGrady, E.
中科院分区：
文献类型：
--
作者：
Hopkins, P. M.;Girard, T.;McGrady, E.
恶性高热在国际疾病分类中被定义为在全身麻醉期间发生的进行性危及生命的高热反应。恶性高热有潜在的遗传基础，遗传易感个体如果暴露于任何强效吸入麻醉剂或磺胺甲铵，就有发生恶性高热的风险。它也可以被描述为一种恶性高代谢综合征。恶性高热没有特定的临床特征，除非在早期发现并及时积极地实施治疗，否则这种情况可能是致命的。麻醉师协会先前已经制定了危机管理指南，打算在所有麻醉室中展示，作为恶性高热反应发生时的辅助备忘录。最后一次迭代是在2011年生产的，从那时起，有一些发展需要更新。在这些指南中，我们将提供用于更新危机管理建议的背景信息，但也将提供关于恶性高热临床诊断的更详细指导。这些指南的范围扩大到包括麻醉师处理疑似恶性高热病例的实用指南，一旦急性反应已经逆转。这包括事件期间和事件后的护理和监测信息；手术室和ICU内适当的设备和复苏措施；沟通和团队合作的重要性；为病人及其家属提供辅导的指引；以及如何将患者转诊以确认诊断。我们还回顾了哪些患者在麻醉下可能会增加发生恶性高热的风险，以及在患者的围手术期管理中应该采取哪些预防措施。
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.