MedEdPORTAL (Oct 2015)
Is It Malignant Hyperthermia? Recalcitrant Hyperthermia in a Two-Month-Old Infant After Separation From Cardiopulmonary Bypass
Abstract
Abstract Introduction For anesthesiologists, malignant hyperthermia (MH) is often read about but rarely encountered. Prompt diagnosis of an MH episode is of utmost importance given the near uniform fatality of the disorder if early treatment is not undertaken. Absence of signs typically associated with an occurrence of MH may delay the diagnosis and therefore treatment, increasing the potential for morbidity and mortality. This resource was created for anesthesiologists, and although the MH case described takes place in a pediatric patient, the principles discussed are more widely applicable, including to patients not exposed to what are traditionally thought of as triggering anesthetic agents. Methods This resource is a problem-based learning discussion and includes a case description, questions intended to provoke an assessment of the participants' knowledge, a discussion of the case, references, and two reference graphs. The case description and references should be distributed at least 1 week prior to the discussion to allow sufficient time for reading and reflection on the presented problems. An hour should be sufficient for the actual discussion. Results The resource was used at the Society for Pediatric Anesthesia winter conference in San Francisco, California, in October 2013. Group members consisted of pediatric anesthesiologists primarily from academic institutions. Discussion The idea that an episode of MH may occur in the absence of a triggering anesthetic or that MH may be triggered by heat will be novel to many. It is the moderator's responsibility to contain the discussion within the time limits and steer the discussion towards evidence-based data. Limiting the size of the group to five to 12 participants to allow each member to contribute or ask questions is recommended.
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