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

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 Symptoms:

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. Patient:

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 bpm ETCO2 35mmHg - 65mHg Oral temp 38.9 Procedure:

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) Prediction scale : >6 high probability

Discontinued sevoflurane Hyperventilated with 100% O 2 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 Treatment:

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 him by Friday 22 nd November Title 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 dergraduate/visitingelectivesinmedicine/ At least four months, but not more than 12 months prior