Case Study – Anesthetic Drugs

00:01 Let's do a question. Heating up the OR. A 42-year-old woman is undergoing a D&C for fibroids.

00:08 She is under general anesthesia with propofol and halothene. Her heart rate climbs to 145 beats per minute, and her temperature at 8:04 a.m. was 37,5, at 8:08 was 39,6, and at 8:09 was 40,1 degrees.

00:28 Now, if you're still using Fahrenheit, that's 104 degrees, and you can write that down on your stone tablet.

00:34 The gynecologist tells you that the patient is starting to twitch. What is the appropriate action for this patient? Do you A, request an urgent blood test and assess this patient for rhabdomyolysis? B, do you request an urgent urine test to assess for myoglobulinuria? C, do you administer more propofol urgently because she is under-sedated? Or D, do you administer dantrolene urgently? Okay. If you answer D, you can become a doctor.

01:09 If you answered anything else, you should hang up your stethescope now and become a truck driver because really, you need to recognize malignant hyperthermia. This is critical for your training.

01:19 This is going to be critical for your exams. Malignant hyperthermia, dantrolene, within 1 minute or the patient dies.

01:25 So, remember this stuff. It's going to be on your exams, you may even have more than one question on your exam.

01:31 Susceptible individuals may experience malignant hyperthermia when exposed to any potent volatile inhalation anesthetic agent or succinylcholine. The anesthetic agent most strongly associated with malignant hyperthermia is halothane.

01:46 So remember, if an anesthetized patient receiving a volatile anesthetic has hypercarbia, tachycardia, or high temperature, think of malignant hyperthermia first, and look for dantrolene in the answer.