Malignant Hyperthermia

Just wondering on how many know what and how to treat MH?

I know it very well and have treated 3 pts. with it. I was shocked when an anesthesiologist resident didn't know what I was talking about when I questioned MH after he told me the pts. temp went up to 40 c during surgery. Lucky it wasnt' MH.

If I'm not mistaken,, you give them Dontolen (Dontrium), right?

If I'm not mistaken,, you give them Dontolen (Dontrium), right?

I thought it was Dantrolene sodium?Very complex to treat. Lots of cooling measures and monitoring.Scary sounding.

I have worked PACU 4 years and have only seen a "near miss" once. The pt apparently had a type of jaw movement during intubation which led the anesthetist to believe she was a possible MH risk.

Yes, Dantrolene sodium is for MH treatment. And I think it`s the only iv. cure for MF. And also, I think there is no effect of cooling measures if you don`t have Dantrolene for MH treatment.

Yeah the first MH I witnessed was back in 1981, before Dantrolene. The patient a 52 year old male died. I remember running to pack bags of ice around him, and filling gloves with ice to put in his armpits. It was awful. Nowadays if we get a MH sufferer we change all the circuts on the anaesthetic machine plus take all the gasses off the machine plus run the oxygen through the machine for 12 hours.

Just wondering on how many know what and how to treat MH?

I know it very well and have treated 3 pts. with it. I was shocked when an anesthesiologist resident didn't know what I was talking about when I questioned MH after he told me the pts. temp went up to 40 c during surgery. Lucky it wasnt' MH.

Wow! On what planet did that Resident attend Medical School? Dantrium is part of their shtick - if indicated, Dantrium may be given preoperatively as a preventative 45 minutes prior to induction. So far as I know it is the only treatment for Malignant Hyperthermia and can be life saving. Hope that the Resident now has an appreciation of the condition.

Malignant hyperthermia is somehting that every anesthetist (whether CRNA, MD, or AA) has been taught, whether they remember it or not is a different story... While it is extremely rare, it is necessary to know because it is one of those conditions that has an extremely high mortality rate if not caught in time.

It affects most often in children, and its triggering affects are volatile anesthetics and the use of succinlycholine. It is thought to occur because of a defect in the calcium channels in skeletal muscle, allowing higher calcium levels, and sustained skeletal muscle contraction. This sustained contraction results in signs or hypermetabolism, including tachycardia, arterial hypoxemia, metabolic and respiratory acidosis, and increases in core temperature. The tachycardia and increased levels of inspired CO2 will be the early signs...temperature increase will usually be a late sign. In a lot of cases, unexplained tachycardia is all an anesthetist may see during the actual case...it is usually when they get to PACU or ICU that the spike in temperature occurs. Of course, all that depends on length of the case, what type of surgery is going on, etc. Dantrolene is given in divided doses, up to 10mg/kg.

If a patient is assumed to have MH after an episode like this, they will usually get a muscle biopsy, and then their entire family will also be told and provided information about the disorder. (This is the way my facility does it - I don't know about others). Since it is an inherited trait, it is important for family members to know in case they have to have surgery at some point. Subsequent procedures for patients at risk for MH are almost always done with a TIVA technique, and a clean machine is used.

I have only seen one case of MH, and considering how long I have been a nurse, I was lucky to have seen even that one. It was in an open heart patient, and temp went as high as 42 - and lived.

Visit

http://www.mhaus.org

This is the MH homepage. They have educational materials for families and staff. I am a member.

Dantrolene is the only med. treatment now. It takes a long time to mix, and has strict instructions on how and what to mix.