Malignant hyperthermia

Question 1

What is the drug we give to combat malignant hyperthermia?

Answer 1

Dantrolene 2,5mg/kg immediately as a IV bolus and then repeat 1mg/kg boluses until we reach a maximum of 10mg/kg

Question 2

What is the pathophysiology of MH?

Answer 2

There is dysfunction in the ryanodine receptor which causes an increase in the calcium release

Question 3

What is the clinical signs of malignant hypertension?

Answer 3

1. sustained muscle contraction
2. rhabdomyolosis
3. acute renal failure
4. rigidity and spasms
5. myoglobinuria

Question 4

What is the most specific and sensitive finding regarding MH?

Answer 4

-An increase in end tidal carbon dioxide(ETCO2)

Question 5

What are the probable associations of malignant hyperthermia?

Answer 5

1. Duchennes dystrophy
2. strabismus
3. hernia
4. scoliosis
5. central core disease

Question 6

What are the 2 exercise associated conditions does it have?

Answer 6

1. exercise induced rhabdomyolisis

2. exhaustive heat stroke

Question 7

What is a way to diagnose MH?

Answer 7

1. In vitro muscle testing which is done in a lab and the biopsy is exposed to halothane and caffeine

Question 8

What are the signs?

Answer 8

1. rigidity
2. masseter spasm
3. tachycardia and hypertension
4. increased end tidal CO2
5. HYPOXIA
6. Dysarrthmias
7. temperature

Question 9

What are the side effects of dantrolene?

Answer 9

• muscle weakness

- phlebitis

Question 10

How do you manage MH?

Answer 10

1. Stop the trigger
2. Give 100% oxygen
3. Give Dantrolene- 2,5mg/kg and then 1 mg/kg every 5 minutes but the maximum is 10mg/kg
4. Lavage or use ice packs to cool the patient
5. Give non polarising muscle relaxant like Rocuronium
6. Take to ICU

Question 11

Which drugs do you need to avoid?

Answer 11

1. Suxamethonium

2. Inhalational drugs

Question 12

What are we worried about in this particular patient?

Answer 12

Acute kidney injury and compartment syndrome

Question 13

How do we treat DIC?

Answer 13

• FFP
• cryoprecipitate
• platelets