Malignant Hyperthermia: What You Need to Know
Malignant Hyperthermia: What You Need to Know
Ivy O. Corlew, BSN, RN, CNOR
Conneaut Medical Center--OR
Malignant Hyperthermia: What You Need to Know
What is Malignant Hyperthermia or MH Malignant Hyperthermia (MH) is a rare, life threatening, pharmacogenetic disorder characterized by hypermetabolic state of skeletal muscle induced by inhalation anesthetics like halothane, sevoflurane, desflurane and the depolarizing muscle relaxant agent like succinylcholine (Rosenberg et al, 2007). Clinical signs are; Increased end tidal CO2 production which is an early sign, tachycardia, tachypnea, trunk or total body rigidity, masseter (jaw) muscle rigidity after succinylcholine which occurs commonly in children, marked temperature elevation (maybe a late sign), respiratory and metabolic acidosis, myoglobinuria(MHAUS, 2011). If left untreated the patient will experience cardiac arrest, kidney failure, blood coagulation problems, internal hemorrhage, and possibly death (slideshare, 2010)
Nursing Assessment Nurses taking care of surgical patients must be knowledgeable regarding MH so they can identify clinical signs and symptoms early on, its emergent treatment, and be able to respond promptly and appropriately. Preoperative assessment by nurses are crucial in identifying the patient, who could be at high risk for Malignant Hyperthermia, so MH triggering agents can be avoided during anesthesia. Example of questions to ask to help screen for MH susceptibility are (AORN 2012):
1. Has anyone ever told you that you had a “bad” reaction to anesthesia?
2. Has anyone ever told you that you or your family member had a problem with anesthesia?
3. Have you or a family member experienced a high fever while under anesthesia?
4. Has anyone ever told you or a family member they had a difficult time opening your jaw during general anesthetic?
5. Has anyone in your family died unexpectedly in the operating room?
6. Have you or anyone in your family experienced sunstroke
Ivy O. Corlew, BSN, RN, CNOR
Conneaut Medical Center--OR
Malignant Hyperthermia: What You Need to Know
What is Malignant Hyperthermia or MH Malignant Hyperthermia (MH) is a rare, life threatening, pharmacogenetic disorder characterized by hypermetabolic state of skeletal muscle induced by inhalation anesthetics like halothane, sevoflurane, desflurane and the depolarizing muscle relaxant agent like succinylcholine (Rosenberg et al, 2007). Clinical signs are; Increased end tidal CO2 production which is an early sign, tachycardia, tachypnea, trunk or total body rigidity, masseter (jaw) muscle rigidity after succinylcholine which occurs commonly in children, marked temperature elevation (maybe a late sign), respiratory and metabolic acidosis, myoglobinuria(MHAUS, 2011). If left untreated the patient will experience cardiac arrest, kidney failure, blood coagulation problems, internal hemorrhage, and possibly death (slideshare, 2010)
Nursing Assessment Nurses taking care of surgical patients must be knowledgeable regarding MH so they can identify clinical signs and symptoms early on, its emergent treatment, and be able to respond promptly and appropriately. Preoperative assessment by nurses are crucial in identifying the patient, who could be at high risk for Malignant Hyperthermia, so MH triggering agents can be avoided during anesthesia. Example of questions to ask to help screen for MH susceptibility are (AORN 2012):
1. Has anyone ever told you that you had a “bad” reaction to anesthesia?
2. Has anyone ever told you that you or your family member had a problem with anesthesia?
3. Have you or a family member experienced a high fever while under anesthesia?
4. Has anyone ever told you or a family member they had a difficult time opening your jaw during general anesthetic?
5. Has anyone in your family died unexpectedly in the operating room?
6. Have you or anyone in your family experienced sunstroke
References: AORN (2012). AORN Malignant Hyperthermia Guideline. In Perioperative Standards and Recommended Practices: For Inpatient and Ambulatory Settings (pp. 5,8-9). Retrieved from http://online.statref.com/titleinfo/fxid-234.html Martin, C. L. (2009). A Practical Guide for Malignant Hyperthermia Management. OR NURSE 2009, 24. Retrieved from www.ORNurseJournal.com Rosenberg, H., Davis, M., James, D., Pollock, N., & Stowell, K. (2007). Malignant Hyperthermia. ORPHANET JOURNAL OF RARE DISEASES. doi:10.1186/1750-1172-2- 21 Malignant Hyperthermia Mock Drill Kit. (2011). Healthcare Professionals. Retrieved from http://www.mhaus.org/healthcare-professionals/#.T6rV3VI2cTY Malignant Hyperthermia (2010, January 28). [Video File]. Retrieved from http://www.slideshare.net/wright958/malignant-hyperthermia-3015604