02.05 Malignant Hyperthermia

Hi guys!  Today I am going to talk to you a little bit about malignant hyperthermia and the surgery patient.

So what is malignant hyperthermia?  Guys I will be honest this is something we as the perioperative team especially anesthesia take super seriously!  This condition is rare but extremely life threatening to a patient if it occurs! It can be triggered by certain medications that are given to put the patient under general anesthesia for their surgery.  It can occur in anyone but is commonly seen in children, adolescents, and has an increased incidence with certain genetic conditions like some muscular dystrophies. Guys prevention is key with MH!

So it’s super important to know the signs and symptoms so we can act quickly!  Hypercarbia, muscle stiffness or rigidity are seen. Also tachypnea can be seen but possibly not if the patient has been paralyzed for the surgery.  Also the patients blood may look very desaturated or dark at the surgical field. A high heart rate, low oxygen saturation and acidosis, metabolic and respiratory can be seen too.

Now here is the sign that gives this condition its name!  One of the last signs that is seen is an elevated body temperature and guys it will rise 1 to 5 celsius degrees every 5 minutes!  This is why it is important to recognize initial signs and symptoms to stop this from happening immediately!

So when can malignant hyperthermia occur?  So the signs can occur during induction or maintenance of anesthesia and also after the procedure.  And guys it might not occur after the first time with anesthesia but it could occur after the second surgery!  Guys I have been a surgery nurse for a long time and I will be honest I haven’t seen malignant hyperthermia! I will attribute this to a great assessment by anesthesia and the perioperative team and also a protocol in place that everyone is aware of!  And I just want to mention that we need to be prepared for malignant hyperthermia in settings other than the operating room especially in the ER where patients may be given anesthetic medications like emergent intubation! We always have to be ready for malignant hyperthermia when anesthesia is involved!

Ok so in terms of malignant hyperthermia what should we assess in the patient?  We want to ask our patients if they have ever had any issues that they can remember with anesthesia in the past.  Patients are not always good historians so asking them about “high fevers” or “heat strokes” during or after surgery can help them to remember.  Also sometimes patients might say that they’ve never had surgery but they did have a family member who died during surgery, this could be an indication of MH.  Also assess the patient for any genetic conditions that could increase their risk as well as their age.

Ok guys what do we do if we suspect that our patient may have had or has a family history of malignant hyperthermia?  It is super important to know your facility protocol and guidelines for this issue. So know your role in this situation!  Most facilities, the hospital where I work included, typically have an emergency malignant hyperthermia cart. If we think there is a chance of malignant hyperthermia the cart will be placed outside of the OR so it is readily available.  You should also be aware of what is inside the cart so you have everything you need. Time is critical and crucial to your patient’s life if they have malignant hyperthermia!

So what do we use to treat the patient who is showing signs of malignant hyperthermia? The primary drug used to treat this issue is dantrolene which is a muscle relaxant. The patient will also be treated with cold IV solutions, diuretics, arrhythmias and acid-base issues will be corrected, and fluid intake and output will be monitored.  Instructions and supplies are typically included with the emergency MH cart.

Okay so which nursing concepts can we apply to malignant hyperthermia? Clinical judgement is crucial for the safety of the malignant hyperthermia patient. The anesthesia team and perioperative team members will work together and collaborate for prevention of malignant hyperthermia or treatment if necessary.

Okay so let's look at a few key points of malignant hyperthermia. This condition is rare but life-threatening if it occurs.   It's commonly associated with general anesthesia medications, it can occur in anyone but there is an increased incidence in children, adolescents, and patients with certain genetic conditions.  Signs of malignant hyperthermia are hypercarbia, hypoxia, muscle stiffness or rigidity, dark blood that can be seen during surgery and one of the last signs to occur is an elevated temperature. We will assess our patients preoperatively for any history of anesthesia reactions or a “high fever” that they can remember during or after a surgery. We are also going to ask them about any family history of anesthesia reactions. If we recognize something we will notify anesthesia and they can alter their anesthesia medications for prevention.   Know your facilities policy and guidelines and also where your emergency MH cart is. If MH occurs in your patient dantrolene is the primary drug for treatment. We also use chilled IV solutions, treat acid base issues and cardiac arrhythmias, and diuretics are also given. We teach our patients to provide a thorough medical and surgical history and also a family history and as always they can ask questions!

Okay guys I hope you enjoyed this lesson and learned important information on malignant hyperthermia!  Make sure you check out all the resources attached to this lesson, as well as the rest of the lessons in this course. Now, go out and be your best self today. And, as always, happy nursing!