If there is a possible triggering effect of active rewarming during CPB or in the postoperative period (something not completely understood yet), then in patients with a presumptive history of MH undergoing cardiac surgery, normothermic CPB and off-pump surgery are alternatives that should be considered individually.

Sternal wound infection occurs in as many as 5% of patients, leading to sternal wound dehiscence, with a reported incidence of mediastinitis in 0.4% to 6.9% of patients. These complications often lead to significant morbidity, with reported mortality rates of more than 50%. Today, the management of sternal dehiscence and infection involves wide debridement of devitalized infected soft tissue and bone, culture-specific antibiotics, and flap closure (eg, muscle, musculocutaneous, and omentum) to achieve wound healing. Thus, the mortality rate from sternal wound dehiscence dropped to less than 10%.2,3