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Surgery
Published in Seema Khan, Get Through, 2020
Malignant hyperthermia is reported to occur in 1 in 50 000 anaesthetics. The condition is inherited in an autosomal dominant manner. Symptoms include muscle rigidity, fever, tachycardia, renal failure and cardiac arrhythmias.
Environmental Emergencies
Published in Anthony FT Brown, Michael D Cadogan, Emergency Medicine, 2020
Anthony FT Brown, Michael D Cadogan
Malignant hyperthermia syndrome A rare autosomal dominant disorder that develops during or after receiving an inhalational anaesthetic or suxamethonium.Characterized by muscular rigidity, hypercapnoea, tachycardia, hypertension, mottled diaphoretic skin and cardiac arrhythmias.
General Anesthetics
Published in Sahab Uddin, Rashid Mamunur, Advances in Neuropharmacology, 2020
Aman Upaganlawar, Abdulla Sherikar, Chandrashekhar Upasani
In spontaneous breathing patients, nitrous oxide causes increase in rate of respiration and decreases tidal volume without affecting minute ventilation and PaCO2. In hypoxic condition, the higher concentration of nitrous oxide markedly depresses the ventilation (Brunton et al., 2011). It has vasodilator effect on cerebral blood flow that is, increases both blood flow of cerebra and intracranial pressure. The concomitant administration of nitrous oxide along with other intravenous anesthetic agent results in decrease in blood flow of cerebra on the other hand when co-administered with halogenated inhalational anesthetics; it reduces the cerebral blood flow that is, reduced vasodilatory effect (Brunton et al., 2011). Nitrous oxide neither relaxes skeletal muscle nor enhances the effects of neuromuscular blocking drugs. It does not trigger malignant hyperthermia (Brunton et al., 2011; Sharma and Sharma, 2017).
Increased rate of complications in myasthenia gravis patients following hip and knee arthroplasty: a nationwide database study in the PearlDiver Database on 257,707 patients
Published in Acta Orthopaedica, 2021
William F Sherman, Victor J Wu, Sione A Ofa, Bailey J Ross, Ian D Savage-Elliott, Fernando L Sanchez
The majority of systemic complications analyzed were statistically significantly more likely and clinically relevant for MG patients relative to patients without MG. This held true for both in-hospital and at 90 days post-discharge. Despite the association of malignant hyperthermia with individuals with a known myopathy or neuromuscular disease (Wedel 1992) there was no occurrence of this complication in either cohort. It is possible the study was underpowered to discern a difference for this very rare complication. Additionally, malignant hyperthermia has a higher odds risk in children compared with adults (Rosenberg and Fletcher 1994, Rosenberg et al. 2015). Because the majority of patients undergoing total joint replacement are adults, low rates of malignant hyperthermia in this population are expected.
Exertional rhabdomyolysis and causes of elevation of creatine kinase
Published in The Physician and Sportsmedicine, 2020
Henrik Constantin Bäcker, Morgan Busko, Fabian Götz Krause, Aristomenis Konstantinos Exadaktylos, Jolanta Klukowska-Roetzler, Moritz Caspar Deml
In analyzing rates of serious medical complications associated with exertional rhabdomyolysis, one patient had to be resuscitated who was otherwise healthy during a long-distance run. No comorbidities were found in the further examination. It remains unclear if the rhabdomyolysis was the cause or consequence of resuscitation as mentioned earlier as this patient likely suffered from an exertional heat stroke. In addition, the mechanic resuscitation and especially fluid resuscitation are known to develop edema of the limb and muscles, which can cause even compartment syndrome and therefore rhabdomyolysis [32]. Otherwise, the patients were relatively healthy without serious complications. However, only in the patient who had to be resuscitated, further examinations for metabolic myopathies or genetic mutations like ryanodine receptor 1 (RYR1) were performed which revealed negative. This mutation causes neuromuscular diseases ranging from congenital myopathies to malignant hyperthermia. The prevalence between genetic mutation (RYR1 and 2 CACNAIS) and malignant hyperthermia is estimated at 1 in 3000 cases; however, the true incidence remains unknown. Hereby, malignant hyperthermia causes hyperthermia, hypermetabolism and muscle breakdown which share triggers such as in exercises [33]. Especially heat and exercises trigger rhabdomyolysis without exertional myalgia and in rare occasion isolated exertional myalgia [34].
Assessment of pre and post-thymectomy myasthenia gravis
Published in Neurological Research, 2019
Suresh C. Bokoliya, Shripad A. Patil
Maximum chance of CSR and best prognosis observed in patients with thymic hyperplasia [31,36]. In our study, MG patients with thymoma had a lesser proportion of improvement and a relatively higher proportion of worsening of symptoms. This finding is in agreement with the previous studies which reported less favorable and more severe outcomes of MG patients with thymoma [9,37]. This unfavorable result might be related to the striated muscle antibodies such as titin, ryanodine receptor and voltage-gated potassium receptor (Kv1.4) that expressed in the thymoma tissue of MG patients [38] which might link to the rise in the severity of MG [39]. Further studies are merited to test these antibodies role in MG patients with thymoma. Detection of anti-N type voltage-gated calcium channel antibodies might be useful for diagnosis of other small cell carcinomas expect thymoma [40]. Mutation in ryanodine receptors type 1 might also trigger the malignant hyperthermia in some of MG patients [41] which leads to further muscle damage and weakness in respiratory muscles. Assessment of malignant hyperthermia prior to thymectomy would be useful to control worsening of the disease.