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Query: UMLS:C0024591 (malignant hyperthermia)
 2,353 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

An overview of several perioperative complications and their management strategies is presented. Operative hypothermia, malignant hyperthermia, bronchospasm, and side effects of spinal opioid agents are discussed. Ramifications of these complications may extend well beyond the operative period and influence patient outcome. Therefore, it is necessary that the surgeon have a fundamental understanding of the pathophysiology and modalities of treatment in the context of anesthesia and surgery.
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PMID:Perioperative complications of anesthesia. 194 66

Postoperative patients have difficulty maintaining thermal balance for several reasons. Normal thermoregulation is suppressed by anesthesia, neuromuscular blocking agents, and other drugs, and cool environmental conditions and exposure contribute to heat loss. Specific patient groups at high risk for hypothermia include infants, the elderly, and the neurologically impaired. Temperature drift, afterfall, shivering, malignant hyperthermia, and fever are among the temperature-related conditions requiring vigilant assessment and nursing action during the postoperative period.
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PMID:Temperature problems in the postoperative period. 209 63

Cardiac arrests (CA) occurring during anaesthesia and recovery can be classified into three groups: CA not related to anaesthesia (NACA), CA related to anaesthesia (ACA), whether partially (PACA) or totally (TACA). In the French survey, NACAs were three times more frequent than ACAs. Nearly 25% of ACAs occurred at induction and consisted mainly in TACAs. Another quarter of ACAs occurred during maintenance and consisted mainly in PACAs. About 50% of ACAs occurred after the end of anaesthesia and had the highest mortality rate. Cardiac arrest corresponds to the status of a heart unable to generate the minimum aortic blood flow required for functioning of vital organs. For the brain, a zero-blood flow of more than 4 seconds results in coma. Consequently CA exists when the time interval between two subsequent efficient systoles is greater than 4 seconds. Anaesthetic agents can result in CA by 1) overdose (absolute, relative), 2) anaphylactoid/anaphylactic reactions, 3) specific effects (acetylcholine-like effect, hyperkalaemia and malignant hyperthermia for succinylcholine; vagal effect of vecuronium and atracurium; cardiotoxicity of bupivacaine) and 4) drug interaction. In hypoxic CA, severe neurologic impairment often still exists at the time of onset of CA. The anaesthesia machine and controlled ventilation can induce CA by hypoxic ventilation, overdose of anaesthetic vapour, excessive CO2 reinhalation, hypoventilation, disconnection, excessive pressure in airways. Cardiac hypothermia can be a cause of CA as well as a cause of unsuccessful CPR. Massive infusion of unwarmed fluids and IPPV with unheated gases generate a temperature gradient within the heart which may result in severe arrhythmias and CA.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Cardiac arrest during anesthesia and recovery period]. 214 88

We report a series of 22 children with complete atrioventricular canal (CAVC) operated upon before the age of one year. The youngest patient was 1 month old and weighed 3 kg. The patients' mean age was 7 months and their mean weight was 5.4 kg. 15 patients had trisomy 21, and in one patient the CAVC was associated with tetralogy of Fallot. The remaining 21 patients had congestive heart failure resistant to medical treatment, with clinical evidence of pulmonary arterial hypertension (PAHT). At the time of surgery, 2 patients had been under artificial respiration for one month. All patients were explored by echocardiography and cardiac catheterization. The mean pulmonary pressure/aortic pressure ratio was 0.92; the mean pulmonary flow rate/systemic flow rate ratio (Qp/Qs) was 2.9/1 and the mean pulmonary resistance/systemic resistance ratio (Rp/Rs) was 0.22. All children were operated upon under deep hypothermia with circulatory arrest (mean 54 min); the patient with tetralogy of Fallot had an additional period of extracorporeal circulation. Fourteen patients had Rastelli's type A CAVC and 8 had type C CAVC. All were operated upon by the classical Rastelli technique, using a single autologous pericardial patch; in none of the patients was the septal "slit" or "commissure" entirely closed. Three patients died within 48 hours of the operation: the first one died of sudden low cardiac output 18 hours after surgery, the second one of persistent PAHT and the third one of malignant hyperthermia. The patient under artificial respiration before surgery could not be disconnected and died on the 30th post-operative day.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Repair of complete atrioventricular canal before one year of age]. 250 95

Myotonia is defined as a persistent contraction of skeletal muscles after their stimulation. This contracture is not prevented or relieved by regional anaesthesia or muscle relaxants. The sensitivity to non-depolarizing muscle relaxants is usually normal. Suxamethonium, neostigmine, hypothermia, a rise in kalaemia should be avoided. There have been case reports of malignant hyperthermia in patients with myotonia congenita. Dystrophia myotonica is the second most frequent of the inherited muscle diseases, after Duchenne's dystrophy. The severity of the disease is due more to the muscular atrophy and the multiple organ involvement than to the abnormal contraction. Atrioventricular heart block and dysrhythmias are more common than heart failure. Prolonged apnoea and pneumonia are the main risks of anaesthesia. In severe cases, exists a restrictive respiratory insufficiency which is preceded by a fall in the maximum expiratory pressure. Dysphagias and inefficient coughing may occur early. An increased susceptibility to hypnotic drugs and opiates is a common feature. Spontaneous sleep apnoeas should be sought before anaesthesia, especially by using pulse oximetry. The anaesthetic implications are reemphasized.
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PMID:[Anesthesia in myotonia]. 253 24

A review of 324 cases reported to the Anaesthetic Mortality Assessment Committee over a five year period confirms a low incidence of cases associated primarily with anaesthesia. The committee has identified potential problem areas affecting anaesthesia which require continued vigilance on the part of the anaesthetist. These include the fluid balance of patients, the potential for hypothermia, altered patterns of drug action in the elderly and critically ill and the influence of other disease processes-notably those affecting the heart. As well there are the rare problems more directly associated with anaesthesia such as hypersensitivity reactions and malignant hyperpyrexia. Technical problems during anaesthesia such as misplacement of the endotracheal tube are not commonly associated with death, but because they are preventable, are of particular importance.
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PMID:The Anaesthetic Mortality Assessment Committee 1979-1984. 345 11

A 5-year-old previously healthy girl, received general anaesthesia for performing an appendectomy. After administration of succinyl choline (20 mg, twice repeated) and halothane (increasing to 2 per cent by volume), the following symptoms of malignant hyperthermia became manifest during anaesthesia: rigor, tachycardia, cardiac dysrhythmia, temperature increase to 42.6 degrees C; anaesthesia was effected with 2 litres O2/min, 4 litres N2O/min, halothane 1.5-2 per cent by volume, using the Kuhn system. Cooling reduced the temperature at first to 40.6 degrees C and subsequently, with additional intravenous administration of dantrolene (initially rapidly 20 mg equal 1 mg/kg body weight, then 10 mg/kg body weight X 24 hrs) within an hour to 37.5 degrees C. The postoperative phase was uncomplicated. The pattern of symptoms and therapy are critically reviewed. Basing on the cases described in literature, as known to the authors, the value of dantrolene in respect of treatment of malignant hypothermia in man is reviewed.
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PMID:[Malignant hyperthermia - therapy results with dantrolene. A case report]. 666 Apr 45

Neuroleptic malignant syndrome and malignant hyperthermia share two cardinal clinical features: hypothermia and rigidity. Both syndromes can result in rhabdomyolysis and have high mortality rates if left untreated. This article reviews each syndrome and its pathogenesis and treatment.
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PMID:Neuroleptic malignant syndrome and malignant hyperthermia. Important issues for the medical consultant. 809 87

Disorders of skeletal muscle and peripheral nervous system are collectively called neuromuscular disorders (NMD). Important for anesthesia is that these disorders show various symptoms and have a high risk during general anesthesia. Especially administration of succinylcholine and volatile anaesthetics may cause problems. Under special circumstances opioids, nondepolarising muscle relaxants and intravenous anaesthetics can interfere with this kind of disorder, too. Complications during and after anaesthesia may result in malignant hyperthermia, malignant hyperthermia-like reactions and primary or secondary changes relating to the underlying NMD. These include cardiac and respiratory problems, dysautonomia as well as hypothermia or hyperthermia. Thus the perioperative management must be determined individually to assure the best possible safety for each patient. Preoperative examination such as ECG, echocardiography, respiratory function test including arterial blood-gas analysis, x-ray of the thorax, neurological status, and extended serum chemistry (such as CK and myoglobin) needs to be done. For premedication no drugs suppressing respiratory function should be administered. Regional anesthesia should be used whenever possible, especially in patients with respiratory and cardiac problems. The dosage of all recommended drugs should be as low as possible. Volatile anaesthetics should not be administered in the majority of NMD and succinylcholine is contraindicated, with the exception of myasthenia gravis. Additionally to the usual intraoperative monitoring, the invasive measurement of blood pressure allows frequent blood-gas analysis. It is obligate to monitor neuromuscular function and body temperature. During recovery special attention should be paid to maintain normal body temperature and electrolytes and acid-base status. The discharge of the patient from the recovery area to the normal ward should be performed only after respiratory function is normalized.
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PMID:[Anesthesia in neuromuscular disorders. Part 1: introduction]. 1186 84

Central core disease and malignant hyperthermia (MH) are both associated with mutations in the RYR1 gene. We report the anaesthetic management of one such patient presenting for coronary artery bypass grafting. Her medication included aspirin 75 mg, atorvastatin 20 mg, isosorbide mononitrate 60 mg, atenolol 25 mg and glyceryl trinitrite sublingual spray as required. The use of aprotinin, statins and moderate hypothermia in patients with central core disease and known susceptibility to MH has not been documented.
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PMID:Anaesthetic management of coronary artery bypass grafting in a patient with central core disease and susceptibility to malignant hyperthermia on statin therapy. 1457 Aug 2


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