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Malignant hyperthermia (MH) is a type of severe reaction that occurs in response to particular medications used during general anesthesia, among those who are susceptible. [1] Symptoms include muscle rigidity , fever , and a fast heart rate . [ 1 ]
There is no specific treatment for central core disease. Certain triggering anesthetics must be avoided, and relatives should be screened for RYR1 mutations that cause malignant hyperthermia. [2] Research has shown that some patients may benefit from treatment with oral salbutamol. [6] [7]
Halothane sensitises the heart to catecholamines, so it is liable to cause cardiac arrhythmia, occasionally fatal, particularly if hypercapnia has been allowed to develop. This seems to be especially problematic in dental anesthesia. [25] Like all the potent inhalational anaesthetic agents, it is a potent trigger for malignant hyperthermia. [5]
Recreational drugs such as amphetamines [17] and cocaine, [18] PCP, dextromethorphan, LSD, and MDMA may cause hyperthermia. [2] Malignant hyperthermia is a rare reaction to common anesthetic agents (such as halothane) or the paralytic agent succinylcholine. Those who have this reaction, which is potentially fatal, have a genetic predisposition. [2]
If nicotinic receptors of the autonomic ganglia or adrenal medulla are blocked, these drugs may cause autonomic symptoms. Also, neuromuscular blockers may facilitate histamine release, which causes hypotension, flushing, and tachycardia. Succinylcholine may also trigger malignant hyperthermia in rare cases in patients who may be susceptible.
Serious side effects can include malignant hyperthermia or high blood potassium. [4] It should not be used in patients with a history of malignant hyperthermia in either themselves or their family members. [3] It is unknown if its use during pregnancy is safe for the fetus, but use during a cesarean section appears to be safe.
Multiple exposures to anesthesia have been found to confer greater deficits in neurotoxicity, cognition and social behavior than single exposures. [3] Nearly all anesthetics that are antagonists of NMDA receptors and/or agonists of GABA A receptors have been shown to cause developmental neurotoxicity and alter cognition and/or behavior. [4]
Anesthetic risk factors include the use of volatile anesthetics, nitrous oxide (N 2 O), opioids, and longer duration of anesthesia. Patient factors that confer increased risk for PONV include female gender, obesity , age less than 16 years, past history of motion sickness or chemotherapy-induced nausea, high levels of preoperative anxiety , and ...