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AA's Thoughts On Malignant Hyperthermia

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Topic: AA's Thoughts On Malignant Hyperthermia
Posted By: JCole
Subject: AA's Thoughts On Malignant Hyperthermia
Date Posted: 17 Sep 2009 at 9:50pm
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Malignant Hyperthermia



Definition

Malignant hyperpyrexia is life-threatening genetic sensitivity to volatile anesthetic agents and depolarising skeletal muscle relaxants

Symptoms

Early

    * Tachycardia, supraventricular and ventricular arrhythmias
    * Cardiac arrest
    * Increase in ETCO2 or hyperventilation
    * Masseter spasm and generalised rigidity
    * Skin discolouration, sweating, cyanosis

Late

Management

Dantrolene is the only clinically available drug for specific treatment of malignant hyperthermia.

    * Suspicion of malignant hyperpyrexia
    * Immediate withdrawal of all precipitating agents (Inhalational anesthetics, Depolarising muscle relaxants)
    * 100% Oxygen and hyperventilation
    * maintain anesthesia with Opioids, Intravenous anaesthetics and nondepolarising muscle relaxants
    * Terminate surgery as soon as possible
    * Prepare and administer dantrolene
    * Dantrolene bolus 2.5mg/kg IV
    * repeat dantrolene bolus at 5 minute intervals
    * Continue with IV infusion of dantrolene at rate of 10mg/kg/day for at least 24 hours
    * Concurrently provide supportive care
          o Body cooling
          o Correct acidosis with sodium bicarbonate
          o Beta-blockers
          o Treat hyperkalaemia, hypercalcaemia, myoglobinuria


References

Krause T, Gerbershagen et al: Dantolene- A review of its pharmacology, therapeutic use and new developements. Anesthesia 2004; 59:364-373


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