hypermetabolic disorder of skeletal muscle ryanodine receptor defect- myopathy- chromosome 19 uncontrolled Ca release into myoctye into myoctye > sustained muscle contraction hypermetaboloic: increased: o2 consumption CO2 heat

MH sequence of events:

1. trigger agent 2. increase cytoplasmic Ca 3. rigidity (may or may not be present) masseter muscle skeletal muscle in 70%

cell damage: muscle breaks down and cell contents leak:

K efflux > hyperK myoglobin CPK can be 20K + acidosis

MH risk factors:

males kids hx: hereditary- autosomal dominant midwestern state- Wisconsin concurrent with muscular disease prior uneventful anesthesia does not rule out prior episode family hx of unexplained death after anes history of: heat stroke, exercise hyperthermia, strabismus, rhabdo

early signs of MH

most specific: ETCO2 RISE tachy tachypnea arrhythmias soda lime exhaustion general muscle ridigity shortly after onset the femoral venous blood gas is mor hypercarbis than arterial because it drains more to skeletal muscle temp is later sign: up to 1C every 5 min

secondary symptoms:

arrhythmia DIC hemorrhage cerebral edema renal failure CNS: seizure blindness coma paralysis

Compensations during MH: heat loss: increase catecholamines: increase CO: increase RR:

heat loss: sweating, flushing Cats: tachy, vasocon: blanch and mottling, increase SVR CO: may or may not keep up with O2 demand, drop mixed venous sat, drop arterial oxygen (depends on shunt), lactic acidosis RR: may or may not keep up with metabolic requirement, increase R drive and increase ETCO2

Labs: pH paCO2 K CK serum myoglobin

Labs: pH <7.25 paCO2 > 60 K > 6 CK > 10K serum myoglobin > 170

late signs:

temp 41 C and up skin mottling sweating hyperK CK peaks 6-12hrs lactic resp/met acidosis myoglobin in urine and blood hyper or hypo Ca> released into myoctye not plasma rhabdo

WHEN??? does MH occur:

acute or delayed Anytime during anesthetic and 1st hr our PACU reports as late as 24 Hours

disorders of association:

Mimics of MH: Tachy due to:

Mimics of MH: fever without rigidity due to:

Mimics of MH: muscle symptoms due to:

Mimics of MH: tachypnea and hypercarbia due to:

Mimics of MH: masseter ridigity due to:

NMS

Fever with non MH:

management: some hot dude better give iced fluid fast

trigger agents:

dantrolene: dose: how to mix: vial/syringe measurements repeat every: max dose: gtt: dose and why? MOA: drug interactions: treat with what other drug: monitor these 3 vital signs:

postoperative management:

causes of increased mortality

treatment of ACIDOSIS

treatment of ARRHYTHMIA

treatment of HYPERTHERMIA

treatment of HYPERKALEMIA

treatment of DIC

treatment of MYOGLOGINURIC RENAL FAILURE

Prevention of MH

masseter muscle rigidity: what is it: how to overcome: peak age: repeating succincholine: if triggering agent is used then: if agent is DC then:

Diagnostic testing of MH

preparing for MH suspect: