Malignant Hyperthermia

When succinylcholine and inhalational agents are used, the patient must be observed for the development of malignant hyperthermia. Malignant hyperthermia is an inherited autosomal dominant defect in calcium sequestration in muscles leading to muscle contracture, increased oxygen consumption, increased lactate production and increased heat production after certain types of anesthesia. This is evident clinically through patient obtundation, muscular rigidity and hyperthermia. Management is with the use of intravenous dantrolene.

Table 4.3. Analgesic agents

Drug

Dose (mg/kg) Class

Effect

Comments

Morphine 1

Meperidine 10 Fentanyl 0.1

Opioid Analgesia, Respiratory failure, broncho sedation spasm, urinary retention, ileus Synthetic Analgesia, Atropine-like effect, opioid sedation myocardial depression Synthetic Analgesia, Rapid metabolism, minimal opioid sedation cardiac and respiratory effects.

In large doses it can produce trunkal rigidity.

References

1. Cousins M, Bridenbaugh P Neural Blockade in Clinical Anesthesia and Management of Pain. Philadelphia: Lippincott-Raven, 1998.

2. Miller R et al, eds. Anesthesia. 5th ed. Philadelphia: Churchill-Livingstone, 2000.

3. Weinerkronish J, Gropper M. Consious Sedation. Philadelphia: Hurley & Belfus Inc., 2001.

4. Yaksh T et al, eds. Anesthesia Biologic foundations. Philadelphia: Lippincott-Raven, 1998.

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