Malignant Hyperthermia

Question 1

malignant hyperthermia: triggering agents

Answer 1

• volatile anesthetics

- succinylcholine

Question 2

malignant hyperthermia: inheritance

Answer 2

• inherited autosomal dominant trait

- mutation in ryr1 gene: alters calcium channels, increased calcium build-up in cells

Question 3

diseases and disorders associated with malignant hyperthermia

Answer 3

• center core disease
• king denborough syndrome
• multiminicore disease
• muscular dystrophy

Question 4

high incidence areas for malignant hyperthermia

Answer 4

• Wisconsin
• Nebraska
• Michigan
• West Virginia

Question 5

how to test for malignant hyperthermia

Answer 5

• caffeine halothane contracture test: thigh muscle biopsy, 4 centers in the US, no mail in samples
• genetic testing for ryr1 gene: 2 centers in US

Question 6

malignant hyperthermia: gas machine

Answer 6

• 10L O2 for >90 seconds

- place charcoal filters

Question 7

malignant hyperthermia: signs and symptoms

Answer 7

• increase in EtCO2
• muscle rigidity - especially masseter muscle
• arrhythmias
• metabolic-respiratory acidosis
• tachycardia
• HTN
• hypoxia
• profuse sweating, hyperthermia

Question 8

how many vials of dantrolene should each facility have?

Answer 8

36

Question 9

dantrolene dose

Answer 9

2.5 mg/kg

Question 10

dantrolene max dose

Answer 10

10 mg/kg

Question 11

dantrolene reconstitution

Answer 11

20 mg of dantrolene in 60 mL of sterile water

Question 12

malignant hyperthermia: post care

Answer 12

• ICU for 36 hours

- 1 mg/kg of dantrolene every 6 hours

Question 13

dantrolene: mechanism of action

Answer 13

-inhibits calcium release