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 l.strulak@gmail.com

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