1. Malignant Hyperthermia
Skills Day Presentation
Prepared by Paige Klem

2. Definition
MH is a potentially fatal, inherited disorder associated with patients given anesthetic triggering agents.
The trigger medication causes an acceleration of metabolism in skeletal muscle
It is an autosomal dominate genetic trait that has been loosely correlated with patients whom develop MH with exercise or exposure to hot environments.
Most cases occur during the administration of anesthesia or during the one-hour time period immediately following surgery.
The syndrome is thought to be due to a reduction in the re-uptake of calcium by the sarcoplasmic reticulum necessary for termination of muscle contraction, resulting in sustained muscle contraction
• Leads to a hypermetabolic crisis manifesting as metabolic and respiratory acidosis, tachycardia, cardiac arrhythmias, skeletal muscle rigidity and heat production

3. Statistics 1:2,000 people are susceptible to MH
More than 1,000 cases a year in the US
1:100,000 surgeries in adults
1:30,000 surgeries in kids
• Not everyone with gene defect linked to MH develops the MH crisis upon exposure to the triggering agents

4. Related Conditions Testing
A muscle biopsy test is available in only 3 labs in the country and it is very expensive.
Testing is limited it its capabilities as there are so many mutations associated with MH.
Related Conditions
Central Core disease
King-Denborough syndrome
Masseter muscle rigidity (MMR)

5. Triggering Agents Inhaled General Anesthetics Succinylcholine**
Desflurane**
Enflurane
Ether
Halothane
Isoflurane
Methoxyflurane
Sevoflurane**
Succinylcholine**
ARH carries Desflurance, Sevoflurane, and Succinylcholine

6. Most Common Symptoms Signs: Tachycardia (sudden and unexplained)
Arrhythmias
Hypercarbia and Hypoxia
Muscle Rigidity
Temperature Elevation

7. Location of MH Kits
Anesthesia Workroom
L&D OR
Location of MH Posters and Contact Info
By each Anesthesia Machine in each OR, Endo, Cath Lab
PACU units (main PACU and L&D PACU)

8. Back of MH Kits Top Cabinet Medications

9. Drawers 1-3

10. Bottom Cabinet

11. Start Emergency Response 1-800-644-9737
Discontinue agents
Get Help
Extra staff
Call MHAUS hotline
Get MH Kit (**Dantrolene)
Mix Dantrolene
2.5 mg/kg
Management of symptoms
Cool patient
Labs and appropriate meds
Treat dysrhythmias

12. Dantrolene is to be reconstituted with 60 mL of Sterile Water per vial
How to mix Dantrolene:
Dantrolene is to be reconstituted with 60 mL of Sterile Water per vial
Action: skeletal muscle relaxant
that impairs calcium dependent
muscle contraction and controls hypermetabolism

13. Know your Role!! Practice within your scope! Video Runners
Mixing of medications
Monitoring of patient
Irrigation of body cavity
Foley Lavage
Line placement
Lab draws
Video

14. Resources
MHAUS.org
Policy OR

15. References:
MHAUS.org
Rosenberg H, Sambuughin N, Riazi S, et al. (2003) [Updated 2013 Jan 31] Malignant Hyperthermia Susceptibility. GeneReviews Retrieved from: