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Barry Malignant Hype

Barry Malignant Hyperthermia

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 in origin? Peripheral because hypermetabolism is caused by the muscles not the hypothalamus.
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 syndrome (NMS)? muscle rigidity and hyperthermia after receiving antipsychotic medications or ALSO REGLAN OR HALDOL.
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 Dantrolene vials required any where anesthesia is being administered? 36
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 trigger agents to? Duchene's muscular dystrophy or other forms of muscular dystrophy.
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
Created by: shamus22