Malignant Hyperthermia exam Already Passed!!

Malignant hyperthermia triggers - Succinylcholine Volatile anesthetics Disease associated with malignant hyperthermia - Central core disease Duchenne muscular dystrophy Myotonic dystrophy Osteogenesis imperfecta Myelomeningocele Strabismus Signs/symptoms of malignant hyperthermia (also name the most sensitive, specific and earliest) - 1) Tachycardia (earliest) 2) Increased ETCO2 despite adequate ventilation (most sensitive/specific) 3) Rigidity 4) Elevated temperature 5) Acidosis 6) Hyperkalemia Treatment of malignant hyperthermia - 1) Stop offending agent 2) 100% oxygen 3) Hyperventilation 4) Dantrolene 2mg/kg every 5 minutes 5) Cool patient 6) Treat hyperkalemia 7) Treat acidosis 8) Treat arrhythmias (do NOT use calcium channel blocker) 9) Send labs - ABG, mixed venous O2, creatinine, coags, CK)10) Foley catheter Testing for malignant hyperthermia risk - 1) Halothane-caffeine contracture test (gold standard) 2) Best indicator is history of malignant hyperthemia episode in self or family member Drugs associated with neuroleptic malignant syndrome - 1) Dopamine antagonists: typical/atypical antipsychotics (aripiprazole, quetiapine, risperidone, ziprasidone, chloropromazine, haloperidol), antiemetics (droperidol, metoclopramide, compazine) 2) Abrupt cessation of dopamine agonists (amantadine, levodopa) Treatment of neuroleptic malignant syndrome - Dantrolene Bromocriptine (dopamine agonist) Dantrolene: 1) Mechanism of action 2) Drug interactions - 1) Inhibits calcium release from sarcoplasmic reticulum 2) Calcium channel blockers cause hyperkalemia and myocardial depression Post-operative monitoring of a patient with risk for malignant hyperthermia - Monitor 1 hour in PACU and 1 hour in phase II (minimum 2 hours total)