Anesthesia Emergency: Malignant Hyperthermia

Anesthesia has been described as hours of boredom punctuated by moments of terror. In this video, I discuss a rare condition called malignant hyperthermia and how it can result in an emergency in the operating room.

0:00 Start
0:31 Introduction
1:16 Frequency
2:49 Pathophysiology
4:25 Preparing for MH patients
5:58 Intraop diagnosis
8:08 Treatment
12:35 Out-of-OR diagnosis

Thanks to Francine S. Yudkowitz MD, board certified pediatric anesthesiologist, for reviewing this video prior to posting.

Music:

The information in this video is not intended nor implied to be a substitute for professional medical advice, diagnosis or treatment. All content, including text, graphics, images, and information, contained in this video is for general information purposes only and does not replace a consultation with your own doctor/health professional.

#Anesthesiology #Residency #MedicalSchool

[saywhat]

Doctors seem to love the expression, "when you hear hoofbeats, think horses not zebras." MH is definitely a zebra. So the hat is a nice touch.

[paulsdrc]

My wife is susceptible to this, we informed her anesthesiologist before a surgery and he said he “did his homework” and produced two large binders of notes. He just said all these notes add up to no gas. He was awesome surgery went perfect.

[rm-dctx]

FANTASTIC explanation. With a family history of MH, presenting in an emergent situation at a major Boston Hospital, I was able to get the Anesthesiologists attention and tell him I had a family history. Literally, everyone stopped talking and the anesthesiologist leaned over me and thanked me for telling him and reassuring me that he understood and then instructed the CRNA to turn off the gas and add a charcoal filter, then I was out, and had no problems with my surgery. I later asked to see him and thanked him. In a brief discussion he thanked me again as it enabled him to ensure a safer operating environment. he added we like to avoid emergencies if at all possible, so always speak up with any anesthesiologist. This was a fantastic review. Well done. Thanks

[BuickDoc]

During my second month of Anesthesia training I did my first anesthetic for a child. I guess they figured it would be an easy case since the child was 4 years old, about as technically easy as it gets. Think in terms of scale: it would be easier to cut a cat's nails (claws, asleep) than those of an elephant or say, a mouse. There is a certain range of size that is easier for humans to work on. And for anesthesia, that optimum size is about 4-5 years of age.
The child had a cancer of the eye, a retinoblastoma, requireing removal of the eyeball. About 2 hours into the case (the new Ophthalmology Residents were doing the case. The fully trained ones could have done it in 30 min.), I noticed that the child was breathing despite being on a ventillator at a setting that had been adequate previously to remove her CO2 production..
The child progressed to an obvious case of MH which I successfully treated with dantrolene, which was only available in oral form then. I had to grind up the capsules and flush them down a Naso-gastric tube, but she survived.
She returned four more times for examination of the other eye under anesthesia. I did her anesthetic every time. As a matter of fact, I did the anesthesia for almost all suspected or known MH cases for the rest of my Residency. I became the Great Guru of MH...Lol

[thewholeroll]

This sort of thing really shows exactly why anesthesiologists are MDs with a high level of specialist training. Plus, also why it's important to have a doctor whose sole role it is and is present & monitoring throughout the whole process

[janetguevara]

I had an episode of Malignant Hyperthermia during a surgery to remove my kidney. I had many surgeries under normal general anesthesia without an episode. During my surgery they had just began to operate when the anesthesiologist notice my temperature spike, he then noticed the muscle rigidity in my jaw and arms. He stopped the surgery and called the MH Hotline. Luckily they had Dantrolene. They used the cooled IV Bags to cool me down. When I finally came around I was in ICU and still had my kidney. I was so upset when they told me what happened! I need to get a medic alert band saying that I have MH. Thank you for covering this topic!

[loriet]

Veterinary tech here, I could listen to you talk all day. Great methodical teaching.

[cames]

Retired OR nurse here. Mandatory yearly written testing and practicals for MH. As many moving parts for MH crisis, assignment cards were handed out so as to avoid confusion. It was also important to know where the closest ice machine was so that along with cold IV solutions and lavages, ice packs could be made for cooling of the patient

[marykirschman]

0:37 great video!!! My brother died of MH six years ago. By the time he was diagnosed, it was too late. His symptoms started a couple days after his surgery. Now I can let the anesthesiologist know if I ever have surgery so they can be aware of the family history.

[benbookworm]

I’m a pharmacy technician that’s recently moved to the inpatient side, and one of my favorite shifts is restocking the operating rooms. I’ve really enjoyed your videos, getting to see why certain medications are used and what the stuff on the walls is talking about.

[thependlewitchproject]

Thank you for posting this. I’m from the UK and its the first time Ive ever seen a video about malignant hyperthermia. My uncle went into an operation for back surgery and after the surgery had finished he had his attack. At the time not many doctors knew about this and unfortunately he passed away. Since then my whole family have had the muscle biopsy test and my mum and grandad both had the gene. This post randomly came up in my feed and honestly it means alot to see it explained in more detail and to know that its getting taught to others who can hopefully save lives. Thank you 😊

[zook]

Had a Motorcycle accident in 1980, aged 18, and broke my Femur. Ambulance could have taken me to 2 hospitals. I had an episode whilst under, but fortunately the hospital I was taken to was our major teaching one, and had stock of Dantrolene. I also spent 3 days in ICU. A year later, had a CHCT that was inconclusive, so had a second CHCT test, confirmed I was MH Positive. 2 large scars from the biopsies, and memories of 12 weeks in traction confined to a bed.

[harvesthawk]

I possibly had a bout with MH during a 1991 surgery. Afterwards, at that time, I had to go to the county library to learn about it because there was no internet yet. When I queried the doctor via a written letter about it several weeks after my surgery he ignored me. To this day if I have surgery I tell the anesthesiologist what happened in 1991 and that I may be susceptible to MH. So far so good.

[SD-ETAC]

One of the best MH lecture/ inservice I’ve ever seen of the 24+ years working in PACU & OR!

[marisaleblanc]

In 1981 my 18 month old sister passed as the result of undiagnosed MH. Following her passing, myself and 7 other family members (two generations) had the muscle biopsy at Maine Medical Center in Portland, ME. We ALL tested positive. Although my sister's passing was a tragedy, it likely saved the lives of so many family members following. This video is so educational and provides a great description of the details of MH. Thank you for sharing your knowledge and expertise.

[xelakir]

I've been shadowing surgeons for the past few months as I've been applying to medical school and I noticed a poster in some of the ORs displaying information about malignant hyperthermia. I knew a little about it from the brief Google searches I did, but this video is amazingly thorough with interesting information and statistics, so thank you!

[marystewart]

I watched your costing video, and then compared it to the last pharmaceutical cost for my surgery. It was comparably close. This gave me much more confidence that I'm not being "over-billed". Thank you!!
I've learned a lot, for a patient, by watching your videos!!

[rnryder]

Way back in 1982 my baby brother had a MH event during reconstruction surgery of his ear. Both my parents were sent to Toronto General Hospital for Biopsy of their thigh muscles. Results indicated that both my mother and father were carriers of the gene. My brother was 5 Years old when that happened and he required alot of therapy afterwards. Thankfully he came full circle.

[Kermittreefrog]

Wow! This video was randomly suggested to me which is great! I was diagnosed with malignant hyperthermia at the age of 2 when I had my appendix out. I almost died. I had no idea this condition may be what lead to me losing my left kidney which I found out 9 years ago does not function and doctors say it has probably been that way my whole life. But my reaction at age 2 seems like it may be the culprit. I do know that any time I have surgery, I have to let the surgeons know immediately and I am very closely monitored. This is a great informative video. Thank you for helping me understand something about myself more then I have ever before.

[lisatague]

As a young RN years ago in a 10 yr span I saw 2 cases . One occurred intra op and one in the PACU . Excellent video !