Malignant Hyperthermia (MH) is a hereditary disorder of the skeletal muscle that is triggered by two key anaesthetic drugs: suxamethonium and volatile agents.
The incidence is around 1/30,000 in the paediatric population and 1/100,000 in adults, and the mortality rate is around 3-5%. MH can occur in patients who have had safe anaesthesia in the past, so unless your patient has had formal testing, it should always be considered as a diagnosis.
What does it look like? 👁👁
Once triggered, a defective receptor (the ryanodine receptor) in the skeletal muscle causes a massive release of calcium and leads to sustained muscle contraction. This muscle contraction causes rigidity, and produces excessive heat, leading to tachycardia and high levels of carbon dioxide in the blood. It then progresses to a life-threatening complex of metabolic acidosis, hyperkalaemia, cardiac arrhythmias and hypotension.
How do you manage it? 👩🔧👷♀️
The most important treatment is prompt administration of the antidote: dantrolene. But management of MH requires a coordinated team approach to manage all dangerous side effects of the condition.
As scary as it sounds, with prompt management you can expect your patient to fully recover in 95% of cases. Check out our other concept series articles for more information!
Ref: https://www.ncbi.nlm.nih.gov/books/NBK430828/
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