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The dangers of MH

The dangers of MH ask an expert By Barbara Sinacori, MSN, RN, CNE, CNRN Associate Professor of Nursing � JFK Muhlenberg Snyder School of Nursing � Plainfi eld, N.J. Greta Kleiman, MSN, RN, APN Associate Professor of Nursing � JFK Muhlenberg Snyder School of Nursing � Plainfi eld, N.J. Q: I’ve heard a lot about malignant acidosis can be seen through arterial blood hyperthermia (MH). What is it and what gases. A comprehensive metabolic panel will A thorough warning signs should I be alert to? show electrolyte and kidney function abnor- pre-op history A: MH is a rare, genetic, life-threatening malities, such as an increase in blood urea may prevent response to anesthesia characterized by nitrogen and creatinine, hyperkalemia, and MH due to skeletal muscle contractions and excessively hypercalcemia. Coagulation studies aid in its genetic high body temperatures that can reach detecting DIC, and urinalysis aids in detect- component. 105 to 108° F (40.6 to 42.2° C). Metabolic ing myoglobinuria. Dysrhythmias can be acidosis—pH below 7.35 and a bicarbonate seen with continuous cardiac monitoring. level below 22 mEq/L—can also occur, Upon detection of MH, anesthesia and the resulting in mental status changes and, concomitant surgery must be stopped. The potentially, coma. Dysrhythmias and cardiac surgical procedure is postponed and the arrest may also ensue if MH is left untreated. trigger agent removed. Immediately adminis- An autosomal dominant gene (RYR1) causes ter dantroline sodium—a skeletal muscle calcium abnormalities when the patient is relaxant—as a reversal agent. Hyperventilate exposed to succinylcholine, a powerful muscle the patient with 100% oxygen and administer relaxant used to temporarily paralyze the I.V. fl uids for hydration and dilution of the respiratory muscles during emergent or trigger agent/succinylcholine. operative procedures. Although succinylcho- When hyperthermia occurs, apply cooling line is the most common offender, MH may blankets; ice to the groin, axilla, and neck be caused by other anesthetics. MH has also areas; or chilled I.V. fl uids. During the use been linked to patients with multiminicore of cooling agents, frequently monitor the myopathy—an inherited skeletal muscle patient’s temperature and perform frequent disorder characterized by hypertonia—and skin assessments. Continuous telemetry is central core disease. essential for monitoring potential arrhyth- The patient with MH presents with a mul- mias and tachycardia. titude of symptoms. Muscle rigidity and A thorough preoperative history may pre- fasciculation are most commonly observed; vent MH. It’s imperative to inquire about a however, be alert for hyperthermia, tachycar- history of reactions to or complications from dia, tachypnea, diaphoresis, arrhythmias, anesthesia in the patient or family. Genetic and cyanosis. testing for RYR1 defects is available to pin- Left untreated, secondary signs of MH point familial tendencies of MH. Instruct the include cardiac arrest, disseminated intra- patient with a known history of or potential vascular coagulation (DIC), acute renal failure, for MH to wear a medical-alert bracelet. ■ myoglobinuria, and rhabdomyolysis. Acid- base and electrolyte imbalances, such as hyper- Learn more about it National Library of Medicine. Malignant hyperthermia. kalemia and hypercalcemia, may also occur. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH Various blood tests, diagnostic proce- dures, and clinical presentations can detect The authors have disclosed that they have no fi nancial the severity of MH. Vital signs will reveal relationships related to this article. tachycardia, tachypnea, hyperthermia, and fl uctuating BP. Respiratory and/or metabolic DOI-10.1097/01.NME.0000432872.67463.f4 www.NursingMadeIncrediblyEasy.com September/October 2013 Nursing made Incredibly Easy! 55 Copyright © 2013 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Nursing Made Incredibly Easy! Wolters Kluwer Health

The dangers of MH

Kleiman, Greta
Nursing Made Incredibly Easy! , Volume 11 (5) – Sep 1, 2013
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Wolters Kluwer Health | Lippincott Williams & Wilkins
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1544-5186
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10.1097/01.NME.0000432872.67463.f4
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Abstract

ask an expert By Barbara Sinacori, MSN, RN, CNE, CNRN Associate Professor of Nursing � JFK Muhlenberg Snyder School of Nursing � Plainfi eld, N.J. Greta Kleiman, MSN, RN, APN Associate Professor of Nursing � JFK Muhlenberg Snyder School of Nursing � Plainfi eld, N.J. Q: I’ve heard a lot about malignant acidosis can be seen through arterial blood hyperthermia (MH). What is it and what gases. A comprehensive metabolic panel will A thorough warning signs should I be alert to? show electrolyte and kidney function abnor- pre-op history A: MH is a rare, genetic, life-threatening malities, such as an increase in blood urea may prevent response to anesthesia characterized by nitrogen and creatinine, hyperkalemia, and MH due to skeletal muscle contractions and excessively hypercalcemia. Coagulation studies aid in its genetic high body temperatures that can reach detecting DIC, and urinalysis aids in detect- component. 105 to 108° F (40.6 to 42.2° C). Metabolic ing myoglobinuria. Dysrhythmias can be acidosis—pH below 7.35 and a bicarbonate seen with continuous cardiac monitoring. level below 22 mEq/L—can also occur, Upon detection of MH, anesthesia and the resulting in mental status changes and, concomitant surgery must be stopped. The potentially, coma. Dysrhythmias and cardiac surgical procedure is postponed and the arrest may also ensue if MH is left untreated. trigger agent removed. Immediately adminis- An autosomal dominant gene (RYR1) causes ter dantroline sodium—a skeletal muscle calcium abnormalities when the patient is relaxant—as a reversal agent. Hyperventilate exposed to succinylcholine, a powerful muscle the patient with 100% oxygen and administer relaxant used to temporarily paralyze the I.V. fl uids for hydration and dilution of the respiratory muscles during emergent or trigger agent/succinylcholine. operative procedures. Although succinylcho- When hyperthermia occurs, apply cooling line is the most common offender, MH may blankets; ice to the groin, axilla, and neck be caused by other anesthetics. MH has also areas; or chilled I.V. fl uids. During the use been linked to patients with multiminicore of cooling agents, frequently monitor the myopathy—an inherited skeletal muscle patient’s temperature and perform frequent disorder characterized by hypertonia—and skin assessments. Continuous telemetry is central core disease. essential for monitoring potential arrhyth- The patient with MH presents with a mul- mias and tachycardia. titude of symptoms. Muscle rigidity and A thorough preoperative history may pre- fasciculation are most commonly observed; vent MH. It’s imperative to inquire about a however, be alert for hyperthermia, tachycar- history of reactions to or complications from dia, tachypnea, diaphoresis, arrhythmias, anesthesia in the patient or family. Genetic and cyanosis. testing for RYR1 defects is available to pin- Left untreated, secondary signs of MH point familial tendencies of MH. Instruct the include cardiac arrest, disseminated intra- patient with a known history of or potential vascular coagulation (DIC), acute renal failure, for MH to wear a medical-alert bracelet. ■ myoglobinuria, and rhabdomyolysis. Acid- base and electrolyte imbalances, such as hyper- Learn more about it National Library of Medicine. Malignant hyperthermia. kalemia and hypercalcemia, may also occur. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH Various blood tests, diagnostic proce- dures, and clinical presentations can detect The authors have disclosed that they have no fi nancial the severity of MH. Vital signs will reveal relationships related to this article. tachycardia, tachypnea, hyperthermia, and fl uctuating BP. Respiratory and/or metabolic DOI-10.1097/01.NME.0000432872.67463.f4 www.NursingMadeIncrediblyEasy.com September/October 2013 Nursing made Incredibly Easy! 55 Copyright © 2013 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.

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Nursing Made Incredibly Easy! – Wolters Kluwer Health

Published: Sep 1, 2013

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