National insights on malignant hyperthermia: a SIAARTI survey on clinical practices, preparedness, and future directions

Background: Malignant hyperthermia (MH) syndrome is a rare pharmacogenetic disorder that can be highly life-threatening if diagnosis and treatment are delayed. The purpose of this study is to assess the knowledge and current practices of Italian anesthesiogists in managing malignant hyperthermia episodes. Methods: We conducted a national survey. Data were collected via an online questionnaire distributed by the Italian Society of Anaesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI). Responses were collected over 15 weeks between July 15 and October 15, 2024, using an online General Data Protection Regulation-compliant platform. Results: A total of 395 anesthetists completed the survey. The majority are employed in public (35%) and university hospitals (26%), with an average of 20 years of professional experience. MH had been managed at least once by 31% of respondents, and 70% of them declared they always report adverse reactions. In over 90% of cases, preventive measures (removal of trigger drugs, ventilator wash-out, perioperative care) are identified, although only 49% reported having an internal protocol in place at their institution. In most centers (89%), non-anesthesiologists are responsible for the storage and supply of dantrolene and only 66% of respondents correctly identify sterile water as its appropriate solvent. Discussion: Our results highlight the need for broader standardization of MH management. Despite limitation in sample size and difference in geographical and hospital setting, the survey reveals a discrepancy between clinical practice and recommended strategies. Although the need for preventive measures as a mean to avoid episodes of MH is widely recognized, there continues to be too much ambiguity on what the exact protocol should be in these situations, leaving room to develop an unequivocal approach that allows the optimal treatment for episodes of MH.