New North American Guideline will help Anesthesiologists assess Malignant Hyperthermia risk
Malignant Hyperthermia Investigation Unit at Toronto General Hospital - UHN
A new guideline led by Dr. Sheila Riazi, professor in the Department of Anesthesiology and Pain Medicine and Medical Director of the Malignant Hyperthermia Investigation Unit at Toronto General Hospital, provides clinicians with a practical framework for assessing malignant hyperthermia (MH) susceptibility before surgery.
Published in both Anesthesiology and the Canadian Journal of Anesthesia (CJA), the guideline was developed collaboratively by Dr. Riazi and colleagues across Canada and the United States, including Dr. Leslie Biesecker, Director of the Center for Precision Health Research at the National Human Genome Research Institute of the U.S. National Institutes of Health. The work has also received an “Affirmation of Value” designation from the American Society of Anesthesiologists as well as endorsement from the Canadian Anesthesiologists’ Society.
Riazi et al’s proposed North American approach is immediately useful for everyday anesthetic practice because it translates a potentially fatal perioperative problem into a practical preoperative decision pathway.
Malignant hyperthermia is a pharmacogenetic disorder triggered by volatile anesthetics or succinylcholine. “As genetic testing becomes more common and contracture testing remains invasive, costly, and available at very few centres in North America, anesthesiologists need a clear way to interpret malignant hyperthermia risk before exposing patients to volatile anesthetics or succinylcholine,” said Dr. Riazi.
The new guideline outlines a stepwise approach that helps anesthesiologists use clinical history, family history and genetic testing to guide perioperative decision-making, including when to use non-triggering anesthetics, pursue further testing or referral, or proceed without additional MH precautions. The framework is designed to support anesthesiologists who may not specialize in MH in making informed clinical decisions.
In addition to the main publication, the authors developed digital supplements designed to help clinicians apply the framework in practice. These include a Variant of Uncertain Significance (VUS) subcategorization guide and a series of hypothetical clinical scenarios that walk users through common preoperative assessment situations using the guideline’s decision-making flowchart.
By standardizing how MH susceptibility is assessed and acted upon across diverse clinical settings, the guideline aims to reduce variability in perioperative decision-making and improve patient safety beyond specialized MH centres.
