The Journal of the Arkansas Medical Society Med Journal Aug 2019 Final 2 | Page 19

atile anesthetics, it is important to always keep in mind the diagnosis and a promptness to treat. This case is exemplary of a situation where suc- cinylcholine is administered to facilitate endo- tracheal intubation without exposing the patient to anesthetic gases. Recognition of this clinical syndrome cannot be undermined. In addition, prior exposure to an offending agent without signs or symptoms of malignant hyperthermia does not rule out the diagnosis. Furthermore, when a patient presents with the above signs and symptoms, it is important to recognize them and treat early. There are not many side effects to treating MH with dan- trolene; whereas, the end result of not treating MH promptly is death. Early recognition and treatment of MH is critical to patient survival and is a necessary skill for first responders, emer- gency personnel, and trauma staff. While more studies are needed to elucidate the actual mag- nitude risk of MH associated with succinylcho- line administration alone, it is becoming clear that organizations where succinylcholine may be used with or without triggering inhalational agents should have both the MH antidote (dan- trolene) and a clearly outlined approach for the management of an MH crisis readily available in case an event occurs. Once the diagnosis of MH is made, the timely response to treatment is potentially life-saving. Emergency treatment of MH consists of dis- continuation of volatile agents and succinylcho- line. The crash cart and dantrolene should be at bedside. Hyperventilation with 100% oxygen at flows of greater than 10L/min should be aimed at achieving lower levels of EtCO 2. Simultaneously, dantrolene should be given at a bolus dose of 2.5 mg/kg through a large-bore intravenous access. Cumulative doses of greater than 10 mL/kg may be given until the symptoms of contracture or ri- gidity resolve. Blood gases may be measured to guide therapy and monitor the degree of metabol- ic acidosis and hyperkalemia. The patient’s core temperature should be cooled if rapidly rising >39°C. The Malignant Hyperthermia Association of the United States (MHAUS) should be contacted for incidence report and further guidance of this life-threatening disorder. Background 1. Iaizzo PA, Wedel DJ. Response to succinyl- choline in porcine malignant hyperther- mia. Anesth Analg 1994;79:143-51. 2. Hopkins PM. Malignant hyperthermia: pharmacology of triggering. Br J An- aesth 2011;107:48-56. 3. Almeida da Silva HC, dos Santos Almeida C, Mendes Brandão JC, et al. Malignant hyper- thermia in Brazil: analysis of hotline activity in 2009. Rev Bras Anestesiol 2013;63:13-9. 4. Riazi S, Larach MG, Hu C, et al. Malignant hyperthermia in Canada: characteristics of index anesthetics in 129 malignant hy- perthermia susceptible probands. Anesth Analg 2014;118:381-7. 5. Visoiu M, Young MC, Wieland K, et al. Anes- thetic drugs and onset of malignant hyper- thermia. Anesth Analg 2014;118:388-96. MAKE THE SMART CHOICE, ADVERTISE IN: For advertising information, contact Penny Henderson at 501.224.8967 or [email protected] NUMBER 2 AUGUST 2019 • 43