CE570 ce567
IN THE OR
continuing education
Malignant Hyperthermia alignant hyperthermia (MH) is a life-threatening syndrome associated with an anesthetic trigger. Awareness of MH by all perioperative team members, from those working in the preoperative holding area to those in the Post Anesthesia Care Unit (PACU), is important in preventing negative patient outcomes. The preoperative nurse plays a crucial role in averting an MH crisis by interviewing every surgical patient for a personal and family history of MH.
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The goal of this continuing education program is to provide OR nurses, physicians, and surgical technologists with information about malignant hyperthermia, including perioperative signs and management of patients who develop malignant hyperthermia. Imagine that you are an OR nurse assessing your first patient of the day. You help the patient to the OR and onto the table. Standard monitors are applied. You note that this is the 30-year-old patient’s first surgery. He receives routine anesthesia induction medications that include fentanyl IV (Sublimaze®), propofol (Diprivan®), and succinylcholine (Anectine®). Intubation is uneventful. The patient is placed on air and oxygen at 50% flow for each with desflurane (Suprane®) 6% inhalational agent. Within minutes, the anesthesia provider notes muscle rigidity in the patient and an increase in exhaled carbon dioxide, heart rate, and blood pressure. The provider 30
OR TODAY | June 2022
suspects malignant hyperthermia based on these initial findings. As a vital part of the team, what will you do to help? What is the best plan of action? How can you help save this patient’s life? Malignant hyperthermia is a potentially life-threatening hypermetabolic state of muscle activity resulting from a defect in skeletal muscle receptors that allows excessive calcium accumulation. It is primarily encountered intraoperatively after the administration of a triggering anesthetic agent. In rare cases, MH can manifest within one hour postoperatively in the PACU. MH is triggered by depolarizing neuromuscular agents such as succinylcholine or volatile halogenated anesthetic agents such as ether, enflurane, methoxyflurane, desflurane, sevoflurane (Ultane®), or isoflurane (Forane®) (MHAUS, 2017a). Providers who work in dental and emergency care settings should also be aware of MH as they frequently administer some of the triggering agents. MH is an autosomal dominant pharmacogenetic clinical syndrome during which a hypermetabolic state develops and becomes a life-threatening emergency (MHAUS, 2017a; Phillips, 2016). The patient’s body becomes hyperthermic because of increased metabolic activity within the skeletal muscle. During an MH crisis, the skeletal muscles are stimulated to contract, muscle metabolism increases, and depolarization occurs with passage of calcium into the intracellular space. The muscles cannot relax and exposure to one or more of the triggering agents causes a rapid intracellular and
Relias LLC guarantees this educational program free from bias. The planners and authors have declared no relevant conflicts of interest that relate to this educational activity. See Page 37 to learn how to earn CE credit for this module.
Goal and Objectives After taking this course, you should be able to: • Identify patients at risk for malignant hyperthermia • Differentiate the early and late signs and symptoms of malignant hyperthermia • Describe the diagnosis and treatment of malignant hyperthermia
extracellular imbalance of calcium that leads to significant energy use and heat production. At the cellular level, as continuing attempts to correct the hypercalcemia are made, heat production increases. Muscle cell relaxation occurs when reuptake of calcium by the sarcoplasmic reticulin occurs. In patients with MH, it appears as if they have an unregulated passage of calcium from the sarcoplasmic reticulum into the intracellular space causing sustained muscle contraction (Zhou, 2015). Calcium is an extracellular ion of the soft tissue that is necessary for nerve impulse transmission, muscle contraction, cardiac function, and blood coagulation. WWW.ORTODAY.COM
