Introduction: A frontline specialty in patient safety
At the University Health Network (UHN), anesthesiologists are at the heart of surgical safety and innovation. In recognition of World Anesthesia Day, Dr. Sheila Riazi highlights how UHN’s Malignant Hyperthermia Investigations Unit (MIHU) is advancing understanding, diagnosis, and treatment of a rare but dangerous condition: malignant hyperthermia. This work places UHN among the world’s top centers for research in a crisis that can erupt within minutes during anesthesia.
What does an anesthesiologist do?
Dr. Riazi emphasizes a clear truth: anesthesiologists do more than administer drugs. “We are responsible for the most critical moments of surgical care,” she notes. From airway management and cardiovascular stability to controlling blood loss, fluid shifts, and postoperative pain, anesthesiologists oversee every stage of a patient’s perioperative journey. Their role extends beyond the operating room into perioperative optimization, critical care, and ongoing patient safety innovations.
Across UHN, anesthesiologists contribute to hyperbaric oxygen therapy for severe injuries, help patients manage chronic pain conditions, and drive research that improves outcomes. They also educate the next generation of learners, ensuring that advances in anesthesia translate into better care for patients now and in the future.
The Malignant Hyperthermia challenge
Malignant hyperthermia is a genetic disorder that can be triggered by certain anesthesia drugs in susceptible individuals. Although rare, it is life-threatening and can escalate rapidly during surgery or in response to heat, exercise, or illness. Dr. Riazi describes it as “the intersection of anesthesia, genetics, and acute crisis management.” Before modern interventions, fatality rates were alarmingly high. Today, with rapid recognition and treatment, outcomes are improving, but mortality remains a concern without preparedness and awareness.
One of the most important steps in keeping patients safe is early identification of risk. A family history of anesthesia complications, unexplained perioperative deaths, or recurrent exercise- or heat-induced muscle problems should prompt discussions with healthcare providers before any procedure. Genetic testing and counseling are increasingly accessible, enabling better risk assessment and prevention strategies.
UHN’s leadership and MIHU
UHN hosts the largest anesthesia care team in Canada, with leadership in numerous subspecialties. The Malignant Hyperthermia Investigations Unit (MIHU) has a storied legacy, dating back to its founding by Dr. Beverly Britt in the 1970s. MIHU remains Canada’s only full-spectrum diagnostic and research program for malignant hyperthermia and is among the most comprehensive in North America. It serves as a critical lifeline for patients who need testing, diagnosis, and access to cutting-edge care.
Under Dr. Riazi’s leadership, MIHU is at the forefront of translational research. Ongoing studies are exploring genetic and molecular biomarkers that could enhance diagnostic accuracy and enable personalized risk assessment. The program also trains teams in malignant hyperthermia response and investigates potential new treatments for muscle-related symptoms seen in survivors. Each discovery brings clinicians closer to faster diagnosis, precise interventions, and better long-term outcomes.
Impact and future directions
The impact of MIHU’s work extends from laboratory benches to patient bedsides. Rapid diagnosis and immediate intervention can turn a crisis into a manageable event, saving lives and reducing complications. Dr. Riazi emphasizes the importance of awareness and preparedness, both within hospitals and across the broader medical community. Family history and individual risk factors must be discussed openly, and genetic information should be leveraged to guide care decisions.
For patients and families, the message is clear: discuss any prior anesthesia complications with your care team, and consider genetic counseling where appropriate. As UHN continues to expand its research and clinical capabilities, the global medical community benefits from better understanding, faster identification, and more effective management of malignant hyperthermia.
Conclusion: A physician-scientist’s call to action
Dr. Riazi’s work exemplifies how anesthesiologists can blend clinical excellence with research leadership to improve patient safety on a continental scale. The MIHU at UHN stands as a beacon for rare disease care, education, and translational science—an essential hub in the global effort to outpace malignant hyperthermia and protect patients during one of life’s most vulnerable moments.
