Condotta anestesiologica in soggetti pediatrici a rischio di ipertermia maligna.

In order to prevent malignant hyperthermia (MH) in children, the authors are currently using a perioperative anaesthetic protocol. In vitro contracture tests with halothane and caffein are performed in selected patients: those with previous signs suggestive of MH, but not severe enough for a definite diagnosis; those with susceptibility to MH in their relatives; those affected by myopathies or other disorders very frequently associated with MH. Even though CK should be considered an unreliable predictor of MH susceptibility, trigger agents are avoided in children with high and constant CK levels. However, prophylactic dantrolene is never employed. In this way, over the last decade no episodes of classic malignant hyperthermia in a large number of children submitted to anaesthesia (more than 50,000) have been observed.