Malignant hyperthermia is an emergency that needs to be recognized during the assessment and notifying the doctor and/or immediately stop surgery also stop the anesthesics agents and start treatment with Dantrolene 2.5mg/kg
What are the signs and symptoms? The earlier symptom is a sudden increase of the CO2, jaw rigidity, rise in skin temperature and rise in the core body temperature, acidosis (when arterial blood pH is lower than 7.35 nEq/L), increase in heart rate, cyanotic skin, mottled skin, intense diaphoresis.
How does Malignant Hyperthermia happen? It is an inherited muscle disturbance that unfolds a hypermetabolic cascade when the patient is exposed to triggering substances in certain inhalation anesthesic and depolarizing muscle sbstances or breaking down muscles, (aka rhabdomyolysis).so the combination of muscle rigidity, acidosis, and hyperthermia causes cell death. Muscle rigidity is caused by the calcium that escapes from the skeletal muscle cells, ATPase starts off metabolic activities, use up all available O2. From these activities can occur internal bleeding, cardiac arrest, failure of vital organs such as the kidneys. Pre-operative assessment is important questioning the history of sudden death during surgery of a relative, is important to know the history of high temperature and dark urine(coca-cola color) after anesthesia procedures, including dental anesthesia. (this does not rule out a present crisis of malignant hyperthermia. There are tests available called caffeine halothane it's a contracture test, the classic signs and symptoms followed by exposure to the triggering anesthesic agents are the important clues. While using Dandtolene avoid calcium channel blockers. Max titration dosage of Dantrolene is 10mg/kg. Sodium bicarbonate is also used to treat acidosis. Another important plan of care is to monitor urine output, both color and volume.
#malignanthyperthermia #rhabdomyolysis #anesthesiology #criticalcare #Hyperkalemia
Sources: Wikipedia and HealthStream
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