Malignant Hyperthermia and Reye Syndrome

what is malignant hyperthermia

complication of general anesthetic that commonly occurs during surgery or upon induction. is rare, autosomal dominant in males that result in altered muscle metabolism

what agents trigger malignant hyperthermia

inhalations (halothane, enflurance, isoflurance) depolarizing muscle relaxants (succinylcholine)

neuromuscular blocking agent

hallmark symptoms of malignant hyperthermia

-muscle rigidity in mouth, jaw, and chest (fasciculations)

-hyperthermia and hypercalcemia, hyperkalemia

-acidosis (metabolic)

-hypercapnia

-elevated serum creatine(signals muscle breakdown)

earliest clinical signs of malignant hyperthermia

unexplained ventricular cardiac dysrhythmia, tachycardia or PVCs

-all of these are associated with increase in CO2 at end of exhalation

symptoms besides hallmark and earliest clinical signs of malignant hyperthermia

tachypnea, cyanosis, skin mottling, hypotension, increased temp, and increased myoglobin in urine

treatment of malignant hyperthermia

dantrolene- works by relaxing skeletal muscles and reducing biochemical actions that cause muscle contractions

emergency care of malignant hyperthermia

stop anesthetic agent and stop surgery is possible. give 100% O2, meds, cooling measure such as iced saline, cooling blankets, ice packs, lavage body cavities

what medications/interventions to give for emergency care of malignant hyperthermia besides dantrolene

bicarb for metabolic acidosis

insulin in D50W if hyperkalemic

cardiac meds if arrhythmias

foley to monitor urine output and look for blood in the urine

prevention of malignant hyperthermia

pre-op screening

CPK level

family history of anesthesia complications/malignant hyperthermia or unexplained death during surgery

what is Reye syndrome

toxic encephalopathy associated with other characteristic organ involvement in children and teens

Etiology of reye syndrome

typically follows a viral infection such as flu or varicella, relationship between reye syndrome and use of aspirin for fevers in children, cause not 100% known

what should you never use to treat fever in children

what is the alternative med

aspirin; acetaminophen

early sign of reye syndrome

effortless vomiting (typically large amounts)

symtpoms of reye syndrome

fever, lethargy, mental status/personality changes, profound impaired consciousness, disordered hepatic function

examples of salicylates

aspirin (ASA) in any form, Excedrin, dristan, pamprin, pepto bismol, alka-seltzer

stage 1 of reye syndrome

lethargy, vomiting, fever dysfunction

stage 2 of reye syndrome

disoriented, delirium, hyperactive reflexes, sluggish-pupils

stage 3 of reye syndrome

coma, hyperventilation, flexion, rigidity

stage 4 reye syndrome

large fixed pupils, deepened coma

stage 5 of reye syndrome

seizures, respiratory arrest, death

testing for reye syndrome

elevated serum ammonia levels, monitor PT/PTT and prolonged bleeding time, increased intercranial pressure, liver biopsy

treatment for reye syndrome

early detection, close I/O monitor, aggressive IV therapy, recovery is typically good sometimes mild neuropsychological deficits present

what is rabdomyolysis

breakdown of muscle tissue