What Is Malignant Hyperpyrexia?

Malignant Hyperthermia (MH) is the only hereditary disease known to cause perioperative death by conventional anaesthetics. It is a subclinical myopathy, that is, the patient has no abnormal manifestations. During exposure to general anesthesia, she was exposed to volatile inhalation anesthetics (such as halothane, enflurane, isoflurane, etc.) and depolarizing muscle relaxants (amber After acetylcholine), skeletal muscle tonic contraction occurs, generating a large amount of energy, leading to a sustained and rapid increase in body temperature. Without specific treatment drugs, general clinical cooling measures are difficult to control the increase in body temperature, which can eventually lead to death.

Malignant fever

Malignant Hyperthermia (MH) is currently the only known cause of conventional anesthesia

Malignant hyperthermia (MH) is a genetic disease characterized by high metabolism. Triggered when the patient is exposed to certain anesthetics. non-

Malignant fever

Defective development of skeletal muscle cell membranes in patients with malignant hyperthermia. Under the action of inducing drugs (mainly volatile anesthetics and succinylcholine), the calcium ion concentration in the muscle cell plasma increases rapidly, muscle contracture and rapid heat production Increased, body temperature rises rapidly. Large amounts of lactic acid and carbon dioxide are produced simultaneously

Sudden seizures can occur in the operating room or resuscitation room after ferocious, malignant development.

(1) Suddenly

(1) Based on typical clinical manifestations

(2) Combined with relevant laboratory tests (mainly phosphocreatine kinase and myoglobin)

(3) Exclude the following reasons that may cause high metabolic status:

The caffeine- flurane isolated skeletal muscle contraction test is the current gold standard for screening and diagnosis of malignant hyperthermia. For patients with (suspected) family history of malignant hyperthermia, a caffeine-halothane contraction test should be performed by muscle biopsy whenever possible to confirm the diagnosis, while guiding the development of anesthetic drugs and anesthesia protocols.

The subjects examined include patients who are clinically highly suspected of malignant fever, first-degree relatives of patients with malignant fever, and who appear during anesthesia

Although malignant hyperthermia is a hereditary disease, the genes responsible for malignant hyperthermia are not completely clear at present, so it cannot be diagnosed by genetic testing. However, genetic testing is performed on patients who have been diagnosed (by skeletal muscle contraction test) Look for genetic mutations. If the same genetic mutation is found in their relatives, their relatives can be diagnosed as malignant hyperthermia;

(1) Inquire about the medical history in detail, and pay special attention to the personal and family history of myopathy and high fever after anesthesia;

(2) For suspicious patients, a caffeine-halothane contraction test should be performed as much as possible through preoperative muscle biopsy to guide anesthesia;

(3) For suspicious patients, the use of drugs that induce malignant hyperthermia should be avoided (see Table 3);

(4) Except during anesthesia

(1) Once considered as MH, the inhalation of anesthetic should be stopped immediately, and it should be carried out with high flow oxygen.

After the condition is stable, the patient's muscle specimens should be taken for a skeletal muscle contraction test to confirm the diagnosis, and further genetic testing should be performed to check the family members and screen the susceptible persons. For susceptible persons, appropriate anesthesia programs can be formulated to avoid the occurrence of malignant hyperthermia.

Malignant hyperthermia can recur, and a successful initial rescue does not mean ultimate success. Intensive monitoring and treatment needed to ensure patient safety through perioperative period