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What is the only clinical entity specifically related to and caused by anesthesia?
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What is MH?
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Barry Malignant Hype
Barry Malignant Hyperthermia
| Question | Answer |
|---|---|
| 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
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