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to this sudden surgical complication? Read on to learn from 2
emergency situations that the hotline experts from the Malignant
Hyperthermia Association of the United States have consulted on.
Case 1: Fatal Result
CAUSE FOR CAUTION
MH-Triggering Agents
Inhaled General Anesthetics:
Desflurane
Enflurane
Ether
Halothane
Isoflurane
Methoxyflurane
Sevoflurane
Depolarizing Muscle Relaxant:
Succinylcholine
An athletic teen presented for elective
ankle surgery. Sevoflurane, which is
known to trigger MH, was administered,
but not the neuromuscular blocker succinylcholine, also known as a triggering
agent. Soon after induction, the signs of
MH began to appear, including increased
end-tidal CO2, increased heart rate and
muscle rigidity in all extremities. In addi-
tion, serum potassium was elevated and acidosis was present. The
anesthesiologist and OR staff moved quickly. Once they made the diagnosis, they secured dantrolene and administered it at the recommended
dose of 2.5mg/kg. They called the
MH hotline, turned off the anesthetic gas and sent laboratory
studies.
Usually these steps would immediately reverse the signs, but not in
this case. In some cases, additional
READY TO RESPOND An MH cart or kit containing an emergency response plan, dantrolene, sterile water, syringes and
other essentials is a must-have wherever general anesthesia
is administered.
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