Malignant hyperthermia safety – A nationwide survey of publicly funded Swedish healthcare

• Published in: Acta anaesthesiologica Scandinavica Vol. 68; no. 6; pp. 788 - 793
• Main Authors: Hellblom, Anna, Miller, William Pettersson, Soller, Maria, Samuelsson, Carolina
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.07.2024
• Subjects: Anesthesia; County councils; dantrolene; Guidelines; Health care; Health Care Service and Management, Health Policy and Services and Health Economy; Health Sciences; Hospitals; Hyperthermia; Hälso- och sjukvårdsorganisation, hälsopolitik och hälsoekonomi; Hälsovetenskap; Institutions; Malignant hyperthermia; Medical and Health Sciences; Medicin och hälsovetenskap; patient safety; Procurement; Requirements specifications; dantrolene; malignant hyperthermia; patient safety
• ISSN: 0001-5172; 1399-6576; 1399-6576
• DOI: 10.1111/aas.14417

Background Malignant hyperthermia (MH) is a rare pharmacogenetic disorder that can lead to a life‐threatening reaction during general anaesthesia with triggering agents. Prompt life‐saving treatment includes the immediate administration of the antidote dantrolene. This study investigated Swedish healthcare providers' awareness and adherence to guidelines and recommendations with respect to MH and whether adherence to safe MH‐praxis varies with hospital care‐complexity level and private versus public management form. Method Agreements and procurement specifications between all 21 Swedish County Councils and privately run surgical care providers were reviewed alongside with questionnaire‐aided collection of information from 62 publicly funded health care providers (both privately and publicly run). Results No procurement requirement specification or contract contained requirements on anaesthesia or aspects of MH. All publicly run hospitals stocked dantrolene and 28 out of 52 (54%) stocked the recommended amount. Seven out of nine (78%) of the privately run institutions stocked dantrolene, and one stocked the recommended amount. Publicly run hospitals adhered to recommendations to a greater extent than privately run institutions, both with respect to stocking of dantrolene (p = .02) and to stocking the recommended amount (p = .03). Conclusions Contracts between Swedish county councils and private surgical care subcontractors rarely outline expectations of standards for the safe practice of anaesthesia such as preparedness to handle a life‐threatening MH reaction. Among Swedish publicly funded anaesthesia providers there is room for improvement in adherence to the EMHG guideline on dantrolene availability. Publicly run hospitals seem to have better compliance with these recommendations than privately run institutions. Raising awareness about current guidelines is important to improve safety for known and unknown MH‐susceptible individuals.