Malignant Hyperthermia

Question 1

What is malignant hyperthermia?

Answer 1

Hypermetabolic state caused by Succinylcholine or halogenated volatile anesthetics in genetically susceptible patients

Question 2

Clinical features of malignant hyperthermia: 
Temp? 
Muscles? 
Activation of what? 
Acid/Base? 
Electrolytes? 
\_\_\_myolysis with elevated \_\_\_ 
Kidneys?

Answer 2

Hyperthermia (rapid, sustained rise)
Rigidity 
Activation of SNS-tachycardia, HTN, tachypnea, arrhythmias 
Acidosis (elevated ETCO2), hyperkalemia 
Rhabdomyolysis-elevated creatine kinase 
AKI-myoglobinuria

Question 3

DDx for MH?

Answer 3

Malignant Hyperthermia
NMS-similar presentation but associated with use of anti-psychotic neuroleptic meds (also treated with dantrolene)
Thyroid storm-fever, tachycardia, AMS
Pheo

Question 4

How do manage MH? What do you need to AVOID?

Answer 4

Stop offending anesthetic, stop surgery
Hyperventilate with 100% oxygen
Call for help
Dantrolene 2.5 mg/kg IV repeat PRN
Cool patient-ice packs, IV fluids, gastric or peritoneal lavage
Treat arrhythmias-AVOID CALCIUM CHANNEL BLOCKERS
Sodium Bicarb 1-2 mEq/kg prn
Monitor temp, electorlytes, ABG, CK, urine output

Question 5

For how long can you continue dantrolene?

Answer 5

1 mg/kg q 4-6 hours x 24-48 hrs, lastly refer for genetic counseling