Clinical discussion... as requested! - page 2

Okay, so a few months ago I was in the ENT room at my clinical site doing some peds cases. A 2 yr. old presents for BMT (ear tubes), otherwise healthy besides seasonal allergies and freq. ear... Read More

  1. by   skipaway
    Quote from jer_sd
    I was under the impression that MH could be triggered by Versed.... is this only with IV administration?
    Midazolam is not a triggering agent for MH.
  2. by   wtbcrna
    Quote from EmeraldNYL
    Great job, wtbcrna, for not even being an official SRNA yet!!

    This is what we ended up doing: The kid already had p.o. Versed on board, but was still kinda squirmy, so we gave some IM Ketamine (I can't remember the exact dose we gave but I was told that a good sedation dose would be to give an IV induction dose IM). My peds rotation is my very last one so you can understand how freaked out I was at this whole situation because I hadn't even done peds yet! Anyhoo, we changed the soda lime on the machine, removed the vaporizers so we wouldn't accidently use them, and flushed the machine at 10 liters for about 15 min. or so. We then started an IV and used a Prop gtt. The case turned out fine it was just a lot of extra work. And of course, we monitored EtCO2 and temp. the whole time just in case. Which leads me to another question: What is the FIRST indicator of MH, and what is the most SENSITIVE indicator of MH?

    And whoever posted this is right, the Halothane contracture test is only done at like 6 centers in the U.S so I imagine getting tested is difficult for some people.
    " The unanticipated double or tripling of end-tidal carbon dioxide is one of the earliest and most sensitive indicators of MH" Morgan, Mikhail, & Murray
  3. by   CerebralCRNA
    Quote from paindoc
    ketamine will potentially interfere with determining whether MH is occurring. It causes tachycardia that can be profound....
    I remember in the 80s it was also thought to be a triggering agent.
    Oral or nasal versed is a good preop, then IV, the propofol...safest course.
    Ketamine does not trigger malignant hyperthermia in susceptible swine

    M Dershwitz, FA Sreter and JF Ryan
    Department of Anaesthesia, Massachusetts General Hospital, Boston 02114.
    The use of ketamine in individuals susceptible to malignant hyperthermia (MH) is controversial. We describe our experience with ketamine used for induction and/or maintenance of anesthesia in our herd of swine inbred for susceptibility to MH. A total of 76 MH- susceptible swine were given a total of 112 general anesthetics using ketamine as the induction drug. In 34 of these anesthetics, anesthesia was also maintained with ketamine. Signs of MH did not develop in response to ketamine in any of the pigs.

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