a case of malignant hyperthermia during anesthesia induction with sevoflurane
TRANSCRIPT
CASE STUDY
A case of malignant hyperthermia during anesthesia induction with sevoflurane
Malignant hyperthermia is a chain reaction of symptoms that are triggered in susceptible individuals by commonly used inhalation agents such as halothane, enflurane, isoflurane and sevoflurane and also depolarizing muscle relaxants such as succinylcholine
Increased body metabolism, high temp and muscle rigidity. (early masseter sign)
Increased heart rate and breathing rate
Increased carbon dioxide production (ETCO2)
Acidosis, rhabdomyolysis, hyperkalemia, dysrhythmias, cyanosis, creatinine
AKF due to rhabdomyolysis
Symptoms:
6 year old, 25 kg boy who received anesthesia for strabismus surgery.
NO history of neuromuscular disease or a special family history. NO previous general anesthesia. Preoperative laboratory examinations were within the normal values.
Patient:
Ketamine 50 mg IV prior sedation
sevoflurane 2.5 vol% by mask ventilation
15mg rocuronium bromide, followed by endotracheal intubation
MH was elicited after 2-3mins of sevoflurane administration
with N2O, O2 and rocuronium.
HR increased 160-195 bpm
ETCO2 35mmHg - 65mHg
Oral temp 38.9
Procedure:
DIFFERENTIAL DIAGNOSIS
Respiratory acidosis
Heart involvement ( fibrillations ect)
Metabolic acidosis
Muscle rigidity (generalized rigidity including severe masseter muscle rigidity)
Muscle breakdown (CK >20,000/L units, cola colored urine or excess myoglobin in urine or serum, potassium above 6 mmol/l)
Temperature increase (rapidly increasing temperature, T >38.8°C)
Other (rapid reversal of MH signs with dantrolene, elevated resting serum CK levels)
Family history (autosomal dominant pattern)
Prediction scale : >6 high probability
Discontinued sevoflurane
Hyperventilated with 100% O2 through a new anesthetic circuit.
CALL EMERGENCY HELP
TIVA using Propofol
Dantrolene
Ice packs applied to body for cooling
External Jugular cannulation and foley catheter
Treatment:
Continued:
IV line cooling with cooled IV fluidsSTOP < 38,5Check: K+, CK, ABG, myoglobin, glucoseCorrect hyperkalemiaCorrect acidosisCorrect arrhythmiasControl urinary outputICU/HDU 24hrs observation
ECG CRASH COURSE
Lukasz Strulak [email protected]
Email him by Friday 22nd NovemberTitle email: Ecg course Ankona EDName, Surname , Grade
BLS COURSE
Next semester: We will divide into groups of 6.
Doctor Pluta will teach the first 6.Then that 6 will teach the next 6, ect.
UK Medical Electives
http://www.gla.ac.uk/schools/medicine/undergraduate/visitingelectivesinmedicine/
At least four months, but not more than 12 months prior