Anaesthetic Emergencies

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Anaesthetic Emergencies

• Malignant HyperthermiaDr T E Allan Palmer FRCA
  FANZCA MDallan_at_palmer.net.au

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(No Transcript)
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Description

• Myopathy described Denborough 1962 (Melbourne)
• Hypermetabolic state of skeletal muscle
• Produces hyperthermia as a side effect
• Muscle rigidity
• Rhabdomyolysis
• Multi-organ failure
• Death.
• Autosomal dominant
• 114000 general anaesthetics

• Myopathy described Denborough 1962 (Melbourne)
• Hypermetabolic state of skeletal muscle
• Produces hyperthermia as a side effect
• Muscle rigidity
• Rhabdomyolysis
• Multi-organ failure
• Death.
• Autosomal dominant
• 114000 general anaesthetics

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Triggered by

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Cured by
DANTROLENE
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Clinical Signs

• Tachycardia
• Hypercarbia
• Desaturation
• Hypoxaemia
• Acidosis
• Hypercarbia
• Hypertension

• Muscle rigidity
• Esp trismus
• Failed intubation
• Fever
• gt0.5 degree per half hour
• Hyperkalaemia
• Myoglobinuria
• DIC

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Sting in the tail!

• The fact that the patient has been previously
  anaesthetised with a trigger agent does NOT
  exclude a diagnosis of MH!

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Management of a reaction

• Dont panic
• Get help
• 100 oxygen
• Ventilate
• High minute volume
• Stop all triggering agents
• Diprifusor
• Abandon surgery
• You will need the surgeons help!

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Management of a reaction

• Dantrolene
• Start dissolving early. Takes time you havent
  got.
• Up to 10mg/kg every 15mins
• Active cooling if available
• Blanketrol type body refrigeration
• Cold peritoneal lavage
• ICU supportive measures
• Forced diuresis if myoglobinuria present

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Aftermath

• Screen patient and family with in vitro
  contracture test
• Very specialised unit.
• Sydney, Melbourne, Perth

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Anaesthesia in a known MH
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Questions

• Can Ecstasy trigger MH ?
• Is MH commoner in some operations?
• Are there any symptoms of MH in everyday life?
• Is it commoner than we think?http//www.abc.net.a
  u/health/misc/suddendeath.htm