MALIGNANT HYPERTHERMIA Greg Gordon MD February 2005
MH MH Malignant Hyperthermia Objectives Things to know and do: Participants will: 1. be able to explain the: pathophysiology, clinical presentations, testing for and management of malignant hyperthermia and the MHS patient 2. be able to explain the significance of MMR and its management. 3. keep MH somewhere in mind as they monitor patients, and not hesitate to give dantrolene. 4. easily correctly answer the questions in the MH Quiz .
MH MH “ If any institution does not feel it can manage the MHS child then they should not be anaesthetising any children at all, since it is not the identified child with a nontriggering technique who will cause grief, but the undiagnosed child given a trigger.” Helen Holtby M.B.,B.S. Director of Cardiovascular Anaesthesia Hospital for Sick Children Toronto, Canada PAC List, 10 Dec 04 Malignant Hyperthermia
MH MH pharmacogenetic hypermetabolic state of skeletal muscle induced by inhalational anesthetics or succinylcholine (and maybe stress/exercise)
Incidence - Current Concepts Clinically based information: One in 20,000 to 50,000 anesthetics depending on drugs, population Molecular Genetics based information: MH trait in 1 in 2,000-3,000 patients. Low penetrance
MH MH HCCT for MH vastus muscle 2-3 months after MH episode nontriggers no dantrolene gentle handling of muscle test within 5 hours About $6,000
Guidelines for Molecular Genetic Testing <ul><li>Determine MHS by HCCT </li></ul><ul><li>If MH positive , screen for known mutation </li></ul><ul><li>If mutation positive, </li></ul><ul><ul><li>test other family members for the mutation </li></ul></ul><ul><li>If mutation negative, </li></ul><ul><ul><li>cannot screen family for mutations or determine MH status </li></ul></ul>
MH MH Treatment of an acute episode of MH Stop triggers 100% oxygen 10L/min Dantrolene 3 mg/kg To 10 mg/kg Rx metabolic acidosis, HCO 3 Cool, iced NS IV Rx dysrhythmias, hyperkalemia Monitor ETCO 2 , ABGs, K, UOP, clotting tests