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18 Cards in this Set
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- Back
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AP II EXAM 2 MALIGNANT HYPERTHERMIA
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AP II EXAM 2 MALIGNANT HYPERTHERMIA
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What are the components of MH?
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1. pharmacogenetic disorder
2. triggered by pharmacogentic agents 3. abnormal handling of intracellular Ca++ 4. hypermetabolism 5. death if untreated |
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Hot line
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Reports indicated mortality from MH
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What are the triggering agents?
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1. succinylcholine
2. volatile inhalation agents (except nitrous) 3. extreme exercise (very rare) |
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Clinical presentation
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1. explosion onset during INDUCTION of anesthesia
2. insidious onset during MAINTENANCE of anesthesia 3. insidious onset postop |
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Hyperthermia appears during what stage of MH?
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Late stage
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What factors increase with MH?
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1. CO2
2. HR/ dysrhythmias 3. resp/metabolic acidosis |
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Current concepts on the presence of clinical manifestations of MH?
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1. muscle rigidity may or may not be present.
2. early sign of increased end tidal CO2. 3. Temp. is a LATE sign 4. MH may occur at any point during anesthesia, or at emergence. 5. recrudescence despite Tx |
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What are the signs of MH?
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1. inc. CO2 production
2. rhabdomyolysis 3. marked temp. elevation 4. muscle rigidity |
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Death from MH is usually due to?
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First few hours:
1. hyperkalemia 2. V-Fib Several hours 1. pulmonay edema 2. coagulopathy 3. acid/base imbalance Days later 1. multi-organ failure, brain damage 2. renal decompensation |
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If pt. gets masseter muscle rigidity (MMR), then...
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1. stop triggering agent
2. continue non-triggering agents 3. adm. DANTROLENE 4. check CPK/electrolytes 5. check urine/serum myoglobin 6. inform pt and family |
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Children under 9 y.o that have a cardiac arrest after Sux, in the absence of hypxemia, should be treated with what first?
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Should be treated for acute hyperkalemia first.
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What is the acute phase therapy for MH?
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1. STOP all volatile agent and Succinylcholine.
2. CALL FOR ASSISTANCE 3. HYPERVENTILATE with 100% O2 with flow > 10L/min 4. give DANTROLENE 5. Tx arrythmias 6. Tx hyperthermia 7. |
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Dantrolene dose
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For Tx of MH IMMEDIATE therapy.
2.5 mg/kg 20mg bottle |
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Side effects of dantrolene
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1. cardiac arrest with Ca++ channel blockers
2. thrombophlebitis 3. synergistic action with neuromuscular blockade |
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Post Acute Phase Therapy
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1. continue dantrolene
2. continuously monitor Temp 3. watch for signs of recrudescense, myoglobinurea, renal failure, DIC. 4. observe in ICU |
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Post Acute Phase Therapy
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1. counsel pt and family
2. refer them to MHAUS 3. fill out Adverse Metabolic Reaction to Anesthesia |
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Contraindication for Halothane-Caffeine contrature test
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1. age < 4 y.o (20 kg)
2. < 3 mos. from the event |
