Intraop and recovery emergencies

Question 1

Malignant hyperthermia?

Answer 1

1. Autosomal dominant condition
2. Abnormal calcium homeostasis.
3. Ryanodine receptor abnormality
4. Risk factors - Sux or volatile agent
5. May occur up to 2-3 days post-op

Question 2

Signs of MH ?

Answer 2

1. RIse in ETCO2
2. Rise in temperature
3. Masseter spasm
4. Tachycardia
5. Dysrhythmia
6. Acidosis
7. DIC

Question 3

Mx of MH?

Answer 3

1. Dantrolene - 1 to 10mg/kg
2. Correct electrolyte abnormalities
3. Hyperventilate
4. Correct acidosis
5. Promote diurresis

Question 4

Anaphylaxis ?

Answer 4

1. Kiwi & latex allergy are related
2. IgE mediate hypersensitivity reaction
3. Histamine and serotonin are released
4. About 1 in 5000 - 20,000 incidence
5. Culprits include; NMB, Abx, Latex, chlorhexidine & NSAIDs

Question 5

Diagnosis of anaphylaxis ?

Answer 5

1. Cardiovascular collapse
2. Erythema
3. Bronchospasm
4. Angio-oedema
5. Rash & Urticaria

Question 6

Mx of anaphylaxis?

Answer 6

1. Remove trigger
2. 100% oxygen
3. Adrenaline
4. Fluids
5. Antihistamines
6. Steroids
7. Take serum tryptase - immediately, 1 hour, 6 hours and 24 hours

Question 7

LA toxicity diagnosis & treatment?

Answer 7

1. Agitation, unconsciousness , convulsion, arrhythmia and asystole.
2. CPR is usually of long duration
3. Give amiodarone if required
4. Intralipid 20% IV @ 1.5ml/kg + 15ml/kg/hr - max 12ml/kg or 840mls

Question 8

NMB risks for prolonged blockade?

Answer 8

1. Hypothermia
2. High magnesium
3. Aminoglycosides
4. Acidosis
5. Liver or kidney failure
6. Abnormal levels of pseudochlinesterase