Malignant hyperthermia caused by inhalational sedation with volatile anaesthetics - results of a nationwide survey

Objective: We initiated a survey on the occurrence and frequency of symptoms suspicious of malignant hyperthermia (MH) in the intensive care unit (ICU) as there seems to be an increase in inhalational sedation techniques using volatile anaesthetics. Methods: Between February and March 2018, 768 departmental heads of anaesthesiology and intensive care were asked to complete an online questionnaire. This questionnaire was developed in cooperation with the German Society of Anaesthesiology and Intensive Care Medicine and consisted of 11 questions about potential MH symptoms occurring when using volatile sedation. Results: The total response rate was 17.3% and 69 questionnaires of users of volatile sedation were analysed. Five cases suggested that MH was triggered by this method. All potential MH symptoms were described, among which hypercapnia was reported most frequently. In addition, the results suggested that not all colleagues were familiar with the association between MH and use of volatile sedation, especially if they represented non-anaesthetic disciplines. Conclusion: It was demonstrated that the use of volatile anaesthetics in the ICU is accompanied with a relevant number of symptoms suspicious of MH. A certain lack of knowledge about symptoms, causes and outcomes of MH under ICU conditions may be assumed. An increased use of volatile sedation in the ICU calls for an intensive information and education programme focussing on this serious side effect.