Paediatric malignant hyperthermia

malignanthyperthermia paediatric Mar 30, 2026

Malignant hyperthermia in children is rare, but when it occurs, it escalates quickly. In the perianaesthesia space, it is one of those events where early recognition and confident action can completely change the outcome.

At its core, malignant hyperthermia is a genetic disorder affecting skeletal muscle. When a susceptible child is exposed to triggering agents such as volatile anaesthetic gases or suxamethonium, there is uncontrolled calcium release within the muscle cells. This leads to sustained contraction and a rapid shift into a hypermetabolic state.

The body begins to consume oxygen at a high rate, producing excess carbon dioxide and heat. As this progresses, metabolic acidosis, hyperkalaemia, and muscle breakdown can follow.

🔥 Rapid rise in end-tidal CO₂ is often an early sign

💓 Unexplained tachycardia and arrhythmias may develop
💪 Muscle rigidity, especially masseter spasm, can occur
🌡️ Temperature rise is often a later but critical sign
⚠️ Not all signs need to be present to act

For perianaesthesia nurses, vigilance is key. A rising CO₂ that does not respond to ventilation, combined with unexpected instability, should always prompt consideration of malignant hyperthermia.

Immediate priorities include stopping triggering agents, calling for help, and preparing dantrolene without delay. Dantrolene works by reducing calcium release in muscle, helping to halt the crisis. Cooling, oxygenation, and supportive management follow.

In paediatric care, preparation matters just as much as response. Knowing where the malignant hyperthermia kit is, understanding your role, and recognising early changes can make all the difference.

Early suspicion saves lives. Acting early saves more.

Build Knowledge ✅

Improve Safety ✅

References
Malignant Hyperthermia Australia. (n.d.). Information for anaesthetists.
Sydney Children’s Hospitals Network. (n.d.). Malignant hyperthermia – Children’s Hospital Westmead.

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