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
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
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.
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
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)
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
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
Lukasz Strulak
l.strulak@gmail.com
Email him by Friday 22nd November
Title email: Ecg course Ankona ED
Name, Surname , Grade
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/un
dergraduate/visitingelectivesinmedicine/
At least four months, but not more than 12 months prior