MALIGNANT HYPERTHERMIA ASSOCIATED WITH SUCCINYLCHOLINE DURING GENERAL ANESTHESIA. A SYSTEMATIC REVIEW
Keywords:
malignant hyperthermia; succinylcholine; suxamethonium; general anesthesia; dantrolene; PRISMA 2020Abstract
DOI: https://doi.org/10.46296/yc.v10i19.0937
Abstract
Background: Malignant hyperthermia is a potentially fatal pharmacogenetic hypermetabolic crisis triggered by volatile anesthetics and the depolarizing neuromuscular blocker succinylcholine in susceptible individuals. Early manifestations may include hypercapnia, tachycardia, muscle rigidity, or masseter spasm; hyperthermia is not invariably the first sign. Objective: To synthesize clinical evidence on the relationship between succinylcholine exposure during general anesthesia and the occurrence, phenotype, timing, complications, and mortality of malignant hyperthermia. Methods: A systematic review was conducted according to PRISMA 2020. MEDLINE/PubMed, PubMed Central/Europe PMC, and reference lists were searched through July 27, 2026. Human primary studies reporting malignant hyperthermia events and succinylcholine exposure, either alone or combined with volatile anesthetics, were included. Narrative synthesis was used because of clinical and methodological heterogeneity and registry overlap. Results: Twelve studies were included. A registry-based estimate found a relative risk of 19.6 for malignant hyperthermia with versus without succinylcholine; when restricted to volatile anesthetics, the relative risk was 9.1. In a Canadian cohort of 129 confirmed susceptible probands, 15.5% of index reactions were attributed to succinylcholine alone; another multicenter analysis identified 24 crises after succinylcholine without volatile anesthetics. Co-administration shortened onset time, and pediatric exposure was associated with more masseter spasm, rigidity, and dark urine. Delayed dantrolene and inadequate temperature monitoring were associated with complications and death. Conclusions: Succinylcholine is a clinically important malignant hyperthermia trigger and may precipitate crises in the absence of volatile anesthetics, although most series include combined exposure. Treatment should begin promptly when unexplained hypercapnia, tachycardia, rigidity, or masseter spasm occurs after administration, without waiting for fever. Dantrolene should be immediately available wherever succinylcholine is used.
Keywords: malignant hyperthermia; succinylcholine; suxamethonium; general anesthesia; dantrolene; PRISMA 2020.
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