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Case STUDY

Case STUDY. A case of malignant hyperthermia during anesthesia induction with sevoflurane.

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Case STUDY

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  1. Case STUDY A case of malignant hyperthermia during anesthesia induction with sevoflurane

  2. 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

  3. Symptoms: • 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

  4. Patient: 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.

  5. Procedure: • 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

  6. Differential Diagnosis

  7. Prediction scale : >6 high probability • 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)

  8. Treatment: • 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

  9. Continued: • IV line cooling with cooled IV fluids • STOP< 38,5 • Check: K+, CK, ABG, myoglobin, glucose • Correct hyperkalemia • Correct acidosis • Correct arrhythmias • Control urinary output • ICU/HDU 24hrs observation

  10. ECG CRASH COURSE Lukasz Strulak l.strulak@gmail.com Email him by Friday 22nd November Title email: Ecg course Ankona ED Name, Surname , Grade

  11. 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.

  12. http://www.gla.ac.uk/schools/medicine/undergraduate/visitingelectivesinmedicine/http://www.gla.ac.uk/schools/medicine/undergraduate/visitingelectivesinmedicine/ UKMedical Electives At least four months, but not more than 12 months prior

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