How do anaesthesiologists treat malignant hyperthermia in a full-scale anaesthesia simulator?

Background: Clinical malignant hyperthermia (MH) is rare and usually occurs unexpectedly. Prompt diagnosis and correct treatment is crucial for surviv al of the patient developing fulminant MH. The aims of the present study we re to investigate whether anaesthesiologists could make a correct diagnosis of NTH and to evaluate their treatment of fulminant MH in a simulator. Methods: Thirty-two teams (one anaesthesiologist/ one nurse anaesthetist) w ere exposed to an event of clinical MH in a fullscale simulator. Their perf ormance was videotaped for retrospective analysis of the treatment on the b asis of the recommendations of the Danish Malignant Hyperthermia Register. Results: All 32 teams asked the surgeon to terminate the surgery as fast as possible, switched off the vaporiser and administered 100% oxygen. Althoug h all intended to hyperventilate the patient, only 14 teams actually manage d to perform the hyperventilation. Most problems were found in teams that s witched to manual ventilation. All teams treated the patient with dantrolen e, and symptomatic treatment was initiated by all even though some elements of the full treatment were lacking, possibly due to the limited time avail able. Conclusion: All teams diagnosed MH in the simulator satisfactorily. The sur prising negative finding was that more than half of the participants failed to hyperventilate the "patient" although they intended to do so. This inve stigation shows that the problem in these teams' treatment of MH was more a question of practical management of the resources than lack of theoretical knowledge.