30 year old lady was on the OT and during the mastoidectomy, after having inhalational anaesthesia, suddenly developed fever, increased hea rate, raised BP, acidosis and arrythmia. What is the next best intervention?
This patient is showing features of malignant hypehermia which would have occured secondary to inhalation of halogenated anaesthetics. The mainstay of therapy for an MH crisis is immediate administration of intravenous dantrolene. Malignant Hypehermia : It is an autosomal dominant genetic disorder of skeletal muscle that occurs in susceptible individuals due to exposure to some triggering agents, typically succinylcholine or volatile agents which cause an abnormal rise in intracellular calcium. Clinical features 1. rise in end tidal C02 (1st sign), 2.Masseter muscle spasm 3.tachypnoea (in spontaneously breathing), 4.unstable BP, 5.fall in 02 saturation, 6.cyanosis 7.hypehermia (late) 8.sweating. Blood gas analysis shows increasing hypoxemia and rising pC02, metabolic acidosis, hyperkalemia, increased creatine kinase levels, Moality increases commonly due to ventricular fibrillation. Susceptible individuals : Patient with muscular dystrophy e.g Duchenne Paediatric age (more chance), younger age (less than 15yrs), male sex, eye, head or neck surgeries. Malignant Hypehermia : It is an autosomal dominant genetic disorder of skeletal muscle that occurs in susceptible individuals due to exposure to some triggering agents, typically succinylcholine or volatile agents which cause an abnormal rise in intracellular calcium. Clinical features - 1.rise in end tidal C02 (1st sign) 2.Masseter muscle spasm 3.tachypnoea (in spontaneously breathing) 4.unstable BP 5.fall in 02 saturation 6.cyanosis 7.hypehermia (late) 8.sweating. Blood gas analysis shows increasing hypoxemia and rising pC02, metabolic acidosis, hyperkalemia, increased creatine kinase levels . Moality increases commonly due to ventricular fibrillation. Susceptible individuals : Patient with muscular dystrophy e.g Duchenne Paediatric age (more chance), younger age (less than 15yrs), male sex, eye, head or neck surgeries.
Dantrolene
Sodium bicarbonate
Procainamide
Antipyretics