Barry Malignant Hype
Barry Malignant Hyperthermia
Question Answer
What is the
only clinical
entity
specifically
related to and
caused by
anesthesia?
Malignant Hyperthermia
What is MH?
Inherited disorder of sk
...
Barry Malignant Hype
Barry Malignant Hyperthermia
Question Answer
What is the
only clinical
entity
specifically
related to and
caused by
anesthesia?
Malignant Hyperthermia
What is MH?
Inherited disorder of skeletal muscles
triggered when exposed to inhaled
anesthetics and sux. causes
hypermetabolism, skeletal muscle damage
and hyperthermia
What major
electrolyte
disturbance do
you see with
MH?
8x increase in Ca2+. Calcium reuptake is
blocked.
Is the heat
production in
MH central or
Peripheral because hypermetabolism is
caused by the muscles not the
hypothalamus.
peripheral in
origin?
What are the 2
Hallmarks of
MH?
Increased HR and Increased CO2.
(according to Marybeth HR is the earliest
and most consistent sign)
What type is
the Gene for
MH?
Autosomal Dominant
Is MH more
common in
kids or
Adults?
Kids. Kids are 1:15,000 and adults are
1:20,000-1:50,000
What function
of MH
actually leads
to death?
Lethal cardiac dysrhythmias secondary to
metabolic disorder.
Is
hyperthermia
a good
indicator of
MH?
NO, increased temp is a late and
inconsistent sign. Very late sign!
What steps do
you take for a
pt with
suspected
MH?
1. Stop sx and discontinue all trigger
agents, Call for help and MH cart2.
Hypervent with 100% @ high flow via
clean source 3-4x normal volume3. Give
Dantrolene
What is
Dantrolene
and what is
the dosage?
It is a skeletal muscle relaxant2.5 mg/kg
iv rapid IV push(total dose usually <
10mg/kg)
What do you
give for lethal
or refractory
dysrhythmias?
Procainamide 1.5 mg/kg over 1 min Q5
min up to 15 mg/kg.
What do you
NOT give a pt
with MH
Calcium channel blockers
What are the
anesthetic
options for pts
with the MH
gene?
TIVA, Regional, Local + sedation.
What is MMR Masseter muscle rigidity. The forceful jaw
contraction after sux.
Is there a
corelation
between
MMR and
MH?
Yes, 50% of kids with MMR are MH
susceptible.
What is
neuroleptic
malignant
muscle rigidity and hyperthermia after
receiving antipsychotic medications or
ALSO REGLAN OR HALDOL.
syndrome
(NMS)?
Is NMS
central or
peripheral in
nature?
Central because it involves dopamine
blockade in basal ganglia and
hypothalamus.
How do you
treat NMS?
Give Benzos and in extreme cases you can
give dantrolene (despite the label
warning)
Do NMS pts
need to be
treated as MH
susceptible?
Yes
How do you
treat
hyperkalemia
with MH?
Bicarb 1-2mg/kg even in absence of
ABGhyperventilatediuresisdextrose(50cc)
10 units insulinHydrate
What is the
best indicator
of overall
therapy
progression in
the treament
of MH
Mixed venous blood gases
What is the
minimum
number of
36
Dantrolene
vials required
any where
anesthesia is
being
administered?
What is the
constitution of
Dantrolene in
sterile water?
Is there
anything else
in the
mixture?
20mg vial with 60 ml of sterile water the
solution has 3gm of Manitol
How long
after the first
episode can
MH continue
to relapse?
24-36 hours (pt goes to ICU after OR)
What is
Dantrolene
mechanism of
action?
Direct acting skeletal muscle relaxant. It
works DIRECTLY on the muscle NOT on
the neuro musculuar junction.
Who else
other than MH
people do you
NOT give
Duchene's muscular dystrophy or other
forms of muscular dystrophy.
trigger agents
to?
What is the
gold standard
of MH
Diagnosis?
(CHCT) Caffeine halothane contracture
test.
What is the
number for the
MH
emergency
hotline?
1-800-MH HYPER
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