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Malignant Hyperthermia

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Management of Malignant Hyperthermia in the Operating Room

September 21, 2013

Perioperative staff, which includes pre-operative nurses, surgeons, anesthesia providers, operating room staff, and recovery room nurses should know what malignant hyperthermia (MH) is and how to handle it when it arises. “Malignant hyperthermia (MH) is a pharmacogenetic disorder of skeletal muscle that presents as a hypermetabolic response to potent volatile anesthetic gases such as halothane, sevoflurane, desflurane and the depolarizing muscle relaxant succinylcholine, and rarely, in humans, to stresses such as vigorous exercise and heat” (Rosenberg, Davis, & James, 2007). Almost all patients that are MH susceptible have no characteristics of these changes without anesthesia. It is nearly impossible to diagnose susceptibility without either the exposure to the "trigger" anesthetics or by specific diagnostic testing, such as a muscle biopsy. Examples of key diagnostic features of MH include an unexplained elevation of expired carbon dioxide, muscle rigidity and rhabdomyolysis, hyperthermia, acidosis and hyperkalemia. If the patient is aware of a familial history of MH, and they inform the perioperative staff, they can be better prepared in the event that a crisis does occur. These changes can occur suddenly upon induction of anesthesia or during the surgical procedure, so the staff must be aware of what is happening and any changes with the patient and communicate with each other in the event that MH is suspected. In the surgical setting, communication dynamics differ in times of crisis, especially if there is tension in the room, inexperienced staff, high-risk patients or difficult procedures. During a suspected MH crisis, the Certified Registered Nurse Anesthetist (CRNA) and Anesthesiologist play

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