Hipertermia Maligna

Descripción General

Definición

La hipertermia maligna es una respuesta hipermetabólica en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum un paciente expuesto a un anestésico volátil o succinilcolina que produce fiebre, rigidez muscular, rabdomiólisis, edema Edema Edema is a condition in which excess serous fluid accumulates in the body cavity or interstitial space of connective tissues. Edema is a symptom observed in several medical conditions. It can be categorized into 2 types, namely, peripheral (in the extremities) and internal (in an organ or body cavity). Edema pulmonar y cerebral.

Epidemiología

• Afección inducida por anestesia
• Rara (< 1:100 000)
• Muy peligrosa → 80%–90% mortalidad sin el tratamiento adecuado
• Tasa de curación del 90% cuando se trata de forma apropiada
• Visto en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum pacientes de todas las etnias y distribuciones geográficas
• Dos veces más común en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum hombres
• Hasta el 50% de los LOS Neisseria casos ocurren en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum pacientes < 19 años.

Etiología

Sustancias desencadenantes:

• Anestésicos por inhalación (e.g., halotano, enflurano e isoflurano)
• Succinilcolina (relajante muscular)

Anestésicos “seguros” para pacientes con hipertermia maligna previamente diagnosticada:

• “Gas de la risa” (óxido nitroso)
• Barbitúricos
• Benzodiazepinas
• Etomidato
• Propofol Propofol An intravenous anesthetic agent which has the advantage of a very rapid onset after infusion or bolus injection plus a very short recovery period of a couple of minutes. Propofol has been used as anticonvulsants and antiemetics. Intravenous Anesthetics
• Ketamina
• Opioides
• Relajantes musculares no despolarizantes

Fisiopatología

• Trastorno genético autosómico dominante del hipermetabolismo del músculo esquelético después de la exposición a ciertos anestésicos
• Debido a mutaciones que codifican:
  • Receptores de dihidropiridina → detectan el potencial de acción en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria túbulos T
  • Receptores de rianodina → liberan calcio del retículo sarcoplásmico al AL Amyloidosis espacio intracelular
• Los LOS Neisseria defectos provocan una contracción muscular continua, lo que provoca:
  • ↑ Metabolismo celular (hipermetabolismo)
  • ↓ De adenosin trifosfato (ATP, por sus siglas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum inglés)
  • ↑ Consumo de O₂ y producción de CO₂
  • Hipoxia tisular y acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis láctica
  • ↑ Producción de calor Calor Inflammation
  • Destrucción celular que causa liberación de creatinquinasa y mioglobinuria

Diagnóstico

Características clínicas

Los LOS Neisseria síntomas pueden aparecer en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum cualquier momento durante la anestesia (inducción, mantenimiento, raramente después de la interrupción). Los LOS Neisseria síntomas siguen un patrón regular Regular Insulin; sin embargo, la velocidad de progresión a través de los LOS Neisseria síntomas varía.

Signos tempranos:

• Aumento rápido del dióxido de carbono al AL Amyloidosis final de la espiración: síntoma más temprano
• Arritmias:
  • Taquicardia
  • Ondas T en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum pico
  • Debido a la hiperpotasemia
  • A menudo se malinterpreta como una profundidad de anestesia demasiado baja
• Rigidez muscular (espasmos maseteros específicos de hipertermia maligna inducida por succinilcolina): la presión arterial es inicialmente ↑ (la presión arterial baja es un signo de insuficiencia circulatoria)

Signos tardíos:

• Fiebre (no se requiere para el diagnóstico)
• Rabdomiólisis
• Mioglobinuria
• Insuficiencia renal
• Edema Edema Edema is a condition in which excess serous fluid accumulates in the body cavity or interstitial space of connective tissues. Edema is a symptom observed in several medical conditions. It can be categorized into 2 types, namely, peripheral (in the extremities) and internal (in an organ or body cavity). Edema cerebral
• Edema Edema Edema is a condition in which excess serous fluid accumulates in the body cavity or interstitial space of connective tissues. Edema is a symptom observed in several medical conditions. It can be categorized into 2 types, namely, peripheral (in the extremities) and internal (in an organ or body cavity). Edema pulmonar

Hallazgos de laboratorio

• Acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis metabólica/respiratoria:
  • Acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis respiratoria: causada por ↑ producción de CO₂.
  • Acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis metabólica: debido a la producción de ácido láctico
• Hiperpotasemia: debido al AL Amyloidosis potasio liberado por las células dañadas
• ↑ Creatinquinasa: liberada por degradación muscular
• Mioglobinuria:
  • La degradación de las células del músculo esquelético libera mioglobina.
  • La mioglobina se elimina en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la orina.

Tratamiento

El cuidado en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la unidad de cuidados intensivos (UCI) es necesario, ya que la afección puede reactivarse después de una aparente mejoría.

Acciones inmediatas

• Terminación de sustancias desencadenantes
• Hiperventilación con oxígeno al AL Amyloidosis 100%
• Terminar la cirugía lo antes posible
• Si es necesario, cambiar a anestésicos más seguros (agentes intravenosos).

Dantroleno

• Inhibe el receptor Receptor Receptors are proteins located either on the surface of or within a cell that can bind to signaling molecules known as ligands (e.g., hormones) and cause some type of response within the cell. Receptors de rianodina
• Evita la liberación de Ca CA Condylomata acuminata are a clinical manifestation of genital HPV infection. Condylomata acuminata are described as raised, pearly, flesh-colored, papular, cauliflower-like lesions seen in the anogenital region that may cause itching, pain, or bleeding. Condylomata Acuminata (Genital Warts)²⁺ del retículo sarcoplásmico del músculo esquelético
• Conduce a la relajación muscular
• Tiene efectos negativos mínimos si el paciente no presenta hipertermia maligna

Tratamiento sintomático

• Refrigeración activa:
  • Compresas de hielo en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la ingle
  • Fluidos intravenosos refrigerados
  • Enjuague de la vejiga con líquido frío
• Equilibrar la acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis con bicarbonato de sodio.
• Tratar las anomalías electrolíticas.
• Tratar la hiperpotasemia en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum pacientes con arritmias.

Posibles complicaciones

• Acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis metabólica severa
• Hiperpotasemia
• Insuficiencia renal
• Edema Edema Edema is a condition in which excess serous fluid accumulates in the body cavity or interstitial space of connective tissues. Edema is a symptom observed in several medical conditions. It can be categorized into 2 types, namely, peripheral (in the extremities) and internal (in an organ or body cavity). Edema cerebral
• Edema Edema Edema is a condition in which excess serous fluid accumulates in the body cavity or interstitial space of connective tissues. Edema is a symptom observed in several medical conditions. It can be categorized into 2 types, namely, peripheral (in the extremities) and internal (in an organ or body cavity). Edema pulmonar

Relevancia Clínica

Condiciones relacionadas

• Síndrome serotoninérgico: fiebre, disfunción autonómica, rigidez/espasticidad relacionada con sobredosis de inhibidores selectivos de la recaptura de serotonina (ISRS) u otros antidepresivos. Se presenta con más síntomas gastrointestinales (náuseas, vómitos) que en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la hipertermia maligna.
• Síndrome neuroléptico maligno: reacción rara, idiosincrásica y potencialmente mortal al AL Amyloidosis medicamento neuroléptico (e.g., antipsicóticos). Muy similar al AL Amyloidosis síndrome serotoninérgico, pero sin síntomas gastrointestinales y más rigidez muscular. Se trata de manera similar al AL Amyloidosis síndrome serotoninérgico, al AL Amyloidosis suspender los LOS Neisseria medicamentos causantes y ofrecer terapia de soporte.

Diagnóstico diferencial

Presentaciones con estado mental alterado, disfunción autonómica y fiebre:

• Meningitis Meningitis Meningitis is inflammation of the meninges, the protective membranes of the brain, and spinal cord. The causes of meningitis are varied, with the most common being bacterial or viral infection. The classic presentation of meningitis is a triad of fever, altered mental status, and nuchal rigidity. Meningitis/encefalitis
• Encefalopatía tóxica
• Delirio excitado
• Golpe de calor Calor Inflammation
• Estado epiléptico
• Abstinencia de alcohol o sedantes
• Crisis hipertensiva
• Tirotoxicosis