SIGNS& SYMPTOMS
Early signs of Malignant Hyperthermia
What are rapid rise in body temperature, tachycardia, tachypnea, muscle rigidity and metabolic acidosis?
A complete preoperative assessment includes
What is a family history of muscle rigidity or high fever during anesthesia and unexpected intraoperative deaths?
May be used for life-threatening bradycardia
What is Atropine
Monitor continuously for MH
What is core body temperature and cardiac arrythmias?
Later signs of MH
What are elevated serum creatinine kinase, dark or brown urine, seizures, coma, multi-organ failure?
Cooling measures
What is applying ice to body surfaces, especially the neck, axilla and groin. Infuse cold NS(39.2degrees) and apply a cooling blanket?
May be used for life-threatening wide-complex tachycardia
What is Sodium Bicarbonate?
Avoidance of these drugs is important in MH
What are stimulant drugs, such as cocaine, amphetamines and Ecstasy, because they may cause similar problems?
Common presenting factors of Local Anesthetic System Toxicity
What are arrythmias, conduction disturbances, hypotension and cardiac arrest?
This medication is a muscle relaxant that helps to prevent further muscle contractions and heat production
What is Dantrolene?
This short acting ester local anesthetic may be used for epidural and peripheral nerve block. Its very short half- life offers a degree of safety in inadvertent intravascular injection.
What is Chloroprocaine?
These may reduce the risk of LAST
What is limit the dose of anesthetic, add epinephrine to the local, aspirate prior to each injection, use ultra sound guidance and avoid heavy sedation or general anesthesia during blocks
Risk factors for MH
What are previous episode of MH and family history related to problems with anesthetics?
Treatment of LAST
What is administer a lipid rescue, administer 20% lipid emulsion along with ACLS or when neurotoxicity occurs, a bolus of 1.5ml/kg over 1 minute, followed by an infusion of 0.25ml/kg/min can be used?
Amide local anesthetics are prepared in almost pure S isomer form and are slightly less cardiotoxic and produce fewer CNS symptoms.
What is Ropivacaine?
These are adjustments in ACLS guidelines for LAST
What are small doses of Epinephrine(less than 1mcg/kg) avoid vasopressin's due to pulmonary hemorrhage. Calcium channel blockers are not recommended, Amiodarone is preferred, as local anesthetics and procainamide can exacerbate the existing toxicity
Risk factors for LAST
What are extremes of age(infants and young children and older adults) Cardiac Disease, pregnancy, renal insufficiency and hepatic Disease?
Supportive measures for LAST
What is airway management and seizure control with benzodiazepines?
Bupivacaine has the lowest CC:CNS ratio of the commonly used local anesthetics, followed by
What is Levobupivacaine, Ropivacaine and Lidocaine?
Place patient is transferred to after these occurrences
What is ICU?