Notes in 52 Thermoregulation, Hypothermia, & Malignant Hyperthermia

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Published	12/13/2023	With NO attempt to actively warm, core temperature decreases by {{c1::1℃ to 2℃}} during the first hour of general anesthesia (phase one).
Published	12/13/2023	Hypothermia is defined as a body temperature less than {{c1::36℃}}.
Published	12/13/2023	With NO attempt to actively rewarm the patient, core body temperature usually decreases gradually during phase {{c1::two}} of anesthesia.
Published	12/13/2023	During phase {{c1::two}} of anesthestic heat loss, decreases in core temperature are due to continuous heat loss to the environment (heat loss > he…
Published	12/13/2023	During phase {{c1::three}} of anesthetic heat loss, core temperature reaches steady state as heat loss = metabolic heat production.
Published	12/13/2023	The autonomic response to hyperthermia is vaso{{c2::dilation}} and {{c1::sweating}}.
Published	12/13/2023	Intense {{c1::shivering}} may increase oxygen consumption, CO2 production, and cardiac output.
Published	12/13/2023	{{c1::Malignant hyperthermia (MH)}} is a rare, autosomal dominant, hypermetabolic muscle disease which occurs after exposure to {{c2::halogenated…
Published	12/13/2023	In malignant hyperthermia, an uncontrolled release of {{c1::Ca2+}} inhibits {{c2::troponin}}, resulting in sustained muscle contraction.
Published	12/13/2023	The most common gene implicated in malignant hyperthermia is the {{c1::RYR1 (ryanodine receptor)}} gene on chromosome 19.
Published	12/13/2023	One of the signs of malignant hyperthermia is {{c1::rigidity}} from sustained muscle contraction due to increases in cytoplasmic free calcium.
Published	12/13/2023	An unanticipated doubling or tripling of {{c1::end-tidal CO2}} is an early and sensitive indicator of malignant hyperthermia.
Published	12/13/2023	Most malignant hyperthermia deaths are due to {{c1::DIC}} and organ failure due to delayed treatment with {{c2::dantrolene}}.
Published	12/13/2023	In malignant hyperthermia, lab values typically reveal mixed metabolic and respiratory {{c1::acidosis}} with marked base deficit.
Published	12/13/2023	Susceptibility to malignant hyperthermia may be increased in patients with musculoskeletal diseases such as {{c1::central-core disease}}, {{c2::multi-…
Published	12/13/2023	Any patient who develops {{c1::masseter muscle}} rigidity during induction of anesthesia should be considered potentially susceptible to {{c2::maligna…
Published	12/13/2023	The first and most important step in treating malignant hyperthermia involves cessation of {{c1::volatile anesthetics}} and/or {{c1::succinylcholine}}…
Published	12/13/2023	Patients with malignant hyperthermia should be {{c1::hyperventilated}} with {{c2::100% oxygen}}.
Published	12/13/2023	After immediate discontinuation of the offending agent, the second step in treatment of malignant hyperthermia involves the immediate administration o…
Published	12/13/2023	{{c1::Dantrolene}} interferes with muscle contraction by binding the {{c2::Ryr1}} receptor channel and inhibiting calcium ion release from t…
Published	12/13/2023	The initial dose of dantrolene is {{c1::2.5}} mg/kg IV every {{c1::5}} minutes, with an upper limit of {{c2::10}} mg/kg.
Published	12/13/2023	Every vial of dantrolene is mixed with {{c1::60}} mL of {{c2::sterile water}}.
Published	12/13/2023	Patients with malignant hyperthermia who have persisting metabolic acidosis or hyperkalemia should be treated with {{c1::IV sodium bicarbonate}}.
Published	12/13/2023	{{c2::Calcium channel blockers}} should be avoided in patients receiving dantrolene because this combination can cause {{c1::hyperkalemia}}.
Published	12/13/2023	Patients with malignant hyperthermia may develop {{c2::kidney}} failure from concomitant {{c1::myoglobinuria}}.
Published	12/13/2023	In malignant hyperthermia, {{c1::surface cooling}} is initially achieved with ice packs, cold air convection, and cooling blankets.
Published	12/13/2023	Historically, the {{c1::halothane-caffeine contracture}} test (on a muscle biopsy) is used to diagnose malignant hyperthermia.
Published	12/13/2023	Treatment of muscle rigidity in severe forms of NMS include muscle paralysis, {{c1::dantrolene}}, or a {{c1::dopaminergic agonist (amantadine, bromocr…
Published	12/13/2023	In malignant hyperthermia, lab values typically reveal a reduced {{c1::mixed venous}} oxygen saturation.
Published	12/13/2023	In malignant hyperthermia, the patient may have electrolyte disturbances such as {{c1::hyperkalemia}} and {{c1::hypermagnesemia}}.
Published	12/13/2023	In malignant hyperthermia, volatile anesthetics bind to {{c1::RYR1 (ryanodine)}} receptors, causing {{c2::calcium}} to be released from the sarcoplasm…
Published	12/13/2023	In a patient with malignant hyperthermia, forced diuresis > {{c1::2}} ml/kg/hr is achieved with fluids and loop diuretics.
Published	12/13/2023	It is important to check {{c2::coagulation}} labs in a patient with malignant hyperthermia because it can lead to {{c1::DIC}}.
Published	12/13/2023	The most serious complication of dantrolene is {{c2::muscle weakness}} that may result in respiratory insufficiency or aspiration pneumonia.
Published	12/13/2023	In malignant hyperthermia, {{c1::heat}} is generated from the continuous conversion of {{c2::ATP}} to {{c2::ADP}}.
Published	12/13/2023	In malignant hyperthermia, elevated mitochondrial activity is seen with increased {{c1::oxygen}} consumption and {{c2::carbon dioxide}} production.
Published	12/13/2023	Where is malignant hyperthermia most prevalent (geographical location)?{{c1::In the upper midwest (Wisconsin, West Virginia, and Michigan)}}
Published	12/13/2023	Most cases of malignant hyperthermia occur in {{c1::young males::demographic}}.
Published	12/13/2023	In malignant hyperthermia, there is increased {{c1::Ca-ATPase}} pump activity in order to remove calcium from the cytoplasm.
Published	12/13/2023	After an initial dose of dantrolene for malignant hyperthermia, {{c1::1}} mg/kg of dantrolene should be given every {{c2::6}} hours for {{c3::24}} to …
Published	12/13/2023	Dantrolene is a {{c1::lipid}}-soluble drug that should be dosed on {{c2::total}} body weight.
Published	12/13/2023	Dantrolene should be administered through a {{c2::central line or large bore PIV}} due to the side effect of {{c1::phlebitis}}.
Published	12/13/2023	The autonomic response to hypothermia is vaso{{c2::constriction}} and {{c1::shivering}}.
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