Malignant Hyperthermia

Check out the mhaus website for authoritative info about mh.

http://medical.mhaus.org/PubData/PDFs/treatmentposter.pdf

Here are two good websites re. MH.

http://www.thomasjeffersonuniversityhospital.net/anes/mh/article3528.html

http://www.mhaus.org/

I bet the CRNA's on the board would have some good info. for you.

Was the pt given prophylactic dantrolene?

HR and RR would have been better vitals to closely monitor as temp is usually a late sign. The family Hx of MH triggered many red flags in the OR and i bet the depolerizing agents that cause MH were nowhere near the room.

I was told by one of the PACU nurses the other day that the risk for development of malignant hyperthermia extends to 2 hours post-op. This patient had a family (but not personal) history of MH. In recovery they had been taking a temp every fifteen minutes as a precaution. I continued to do so for the first hour that my patient was on the floor, but I question whether this was necessary.

Can anyone provide me (a floor nurse) with some guidance with regards to this type of situation? TIA

i can assure you it is necessary.

some monitor for atleast up to 4 hours post-op

trust me, when you have an MH reaction, you will NEVER question the severity or rapidity of it all !

Was the pt given prophylactic dantrolene?

No, not as far as I know...

MH can happen as much as 36 hours after surgery!!! I have read and been taught that prophylactic dantrolene does not improve the outcomes and should not be used. The pt should definetly be monitored very closely paying close attention to CO2 as it is the first thing to go up. If MH is suspected pt should be given 100% 02 atleast 10L/min, dantrolene 2-10mg/kg (needs to be continued after started for 36 hrs given every 6hrs), may need ice packs under arm pits, under knees, around neck, and may need to give sodium bicarb in that it will cause acidosis. You will also need to start some fluids to keep the kidneys flushed in that kidney failure could develop. Also will want to watch the K level in that it will go up. If there is a pt/family hx of MH a pt can still have surgery just dont need to use volatile anesthetics or SUCC's, with this known MH alot let common.

AM I ON TRACK, what else should or should not be added

we had a mh patient about 6mos ago. 24yo asian post lap chole. patient did get sux.. hr started to climb into the 140's and even a few runs of svt.. started dantrolene in paccu and rush to icu. for the 1st 6hrs we did nothing but watch retal temp, placed a-line, cooling blanket, fluid bolus after bolus watched myoglobin in urine. gave multiple more doses of dantrolene. temp got as high as 103.8... but within 12hrs post admit he was very much a & o x3. luckily he recoverd well.. but needless to say i've never seen so many mda's in the unit at one time. but the best course of action is to call the malignant htn hotline number, they'll basically talk you through.

we had a mh patient about 6mos ago. 24yo asian post lap chole. patient did get sux.. hr started to climb into the 140's and even a few runs of svt.. started dantrolene in paccu and rush to icu. for the 1st 6hrs we did nothing but watch retal temp, placed a-line, cooling blanket, fluid bolus after bolus watched myoglobin in urine. gave multiple more doses of dantrolene. temp got as high as 103.8... but within 12hrs post admit he was very much a & o x3. luckily he recoverd well.. but needless to say i've never seen so many mda's in the unit at one time. but the best course of action is to call the malignant htn hotline number, they'll basically talk you through.

i'm sure this was more for the ooohs and aaaahs of never seeing MH rather than chipping in type stuff... !

I have also learned NOT to give Lactated Ringers or Calcium channel blockers with Dantrolene.

Your right, Ca channel blockers are a big no-no, but why not LR? I guess the K? It didn't think it had enough to make a huge difference but NS would probably be best and safest.

Watching the CO2, as one person suggested, is the earliest sign but if they transferred them to the floor then they were not watching CO2. This whole situation sounds somewhat strange to me. Did they not find out about the MH until after the case was done? Was it a direct relative or was it the 2nd cousin once removed? If they knew there was a chance before hand then they should have prepared the room without triggers (new or thoroughly flushed machine and no succ's within a mile of the room). If there was a real threat then they should never have left PACU.

Also, if you would have caught the MH by his temp then it was probably too late. Temp is the latest sign, as someone said, and the whole process has been going on way too long if you caught it that way.

If there was a real concern about MH then whoever sent them to the floor was negligent.