Malignant Hyperthermia: Management without DANTROLENE
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Abstract:
Malignant Hyperthermia(MH) is a hypermetabolic syndrome which is quite rare in India. Inhalational anesthetics and succinyl choline have been reported as potent triggering agents of MH. Dantrolene remains the gold standard for treating this life-threatening syndrome.
We encountered a case of malignant hyperthermia in a 34-year-old male undergoing ventricular septal defect closure under general anesthesia. We successfully managed our patient by timely recognition of this syndrome and by administering prompt, effective symptomatic treatment and without dantrolene which was not available in our hospital. JMS 2018;21(1):40-43
Keywords:
Malignant hyperthermia
Dantrolene Sodium
Gold standard (test)
Anesthesiologists from 65 institutions participated in a multicenter study to assess the efficacy of lyophilized intravenous dantrolene sodium in treating anesthetically related malignant hyperthermia (MH). Of 21 patients treated with the drug, eight were judged to have unequivocal MH and were treated according to study protocol. Three were judged to have probable MH and were also treated according to study protocol. All 11 recovered without sequelae from MH and without adverse drug effects. A mean dantrolene dose of 2.5 mg/kg in these patients produced significant changes in clinical and biochemical parameters suggestive of decreased cellular metabolism. Four patients with unequivocal MH were treated with intravenous dantrolene more than 24 h after the diagnosis of MH; this delay in treatment of clinical signs in these patients, the mortality rate was 75 per cent, which is comparable to that reported without dantrolene. The six remaining patients had episodes of questionable MH during or subsequent to anesthesia and were treated with dantrolene. There was insufficient evidence to justify an unequivocal or probable diagnosis of MH, and they, therefore, were not included in the study. All survived and had no adverse drug reactions. Dantrolene therapy resulted in a statistically significantly lower mortality rate than would be expected in MH patients. The study supports animal data suggesting that dantrolene is specific in reversing MH.
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Departments of Anesthesiology and Orthopedics, Stanford University School of Medicine, Stanford, California
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Halothane-induced contractures in isolated muscle fibers from swine susceptible to malignant hyperthermia (MHS) were significantly less when fibers were incubated in KRB plus 6.2 x 10(-6) M dantrolene sodium prior to the administration of 4 per cent halothane. Administration of dantrolene sodium at the time of maximum contraction to NHS fibers in which contractures had been induced by halothane significantly increased the rate of relaxation of these fibers compared with similar fibers not treated with dantrolene sodium. This study indicates possible prophylactic and therapeutic value of dantrolene sodium in malignant hyperthermia and suggests that the previously reported effectiveness of dantrolene sodium in preventing and treating halothane-induced contractures may be due, at least in part, to its direct effect on muscles.
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Abstract Malignant hyperthermia (MH) is a hereditary myopathy, triggered when susceptible patients are exposed to a depolarizing muscle relaxant and/or potent volatile anesthetics. We have studied the effects of dantrolene on the free [Ca 2+ ] i of intercostal muscle biopsies obtained from two MH‐susceptible patients before and after administration of dantrolene orally (2.5 mg/kg for 3 days) and intravenously (1.0 mg/kg 2 hours before the biopsy). The free [Ca 2+ ] i was measured by Ca 2+ ‐selective microelectrodes. The mean resting free [Ca 2+ ] i in the MH‐susceptible muscle before dantrolene treatment was 0.42 ± 0.01 μ M (mean ± SEM, n = 12). The administration of dantrolene reduced this value to 0.27 ± 0.01 μ M ( n = 14). There was no detectable difference in the resting membrane potential after dantrolene. These results represent the first direct demonstration that dantrolene is able to reduc the resting free [Ca 2+ ] i in skeletal muscle of MH‐susceptible patients.
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