Malignant Hyperthermia
Find answers to the most frequently asked questions about MH OR VR Simulation.
Application Overview
Though rare, the death of a patient due to malignant hyperthermia is tragic for the family and the operating room staff. Malignant hyperthermia causes complications in 1 in 100,000 surgical procedures in adults and 1 in 30,000 surgical procedures in children (MHAUS, 2021). Though uncommon, when considering the 234 million major surgical procedures that occur worldwide per year, being prepared for malignant hyperthermia is crucial to any perioperative team member (Thomas G Weiser, 2008). It is crucial that every person in an operating room is confident in identifying early signs of malignant hyperthermia and capable of instituting critical treatment measures in a timely fashion.
Scenario Information
This is a virtual reality simulation of a real-life operating room experience. The patient will be undergoing a surgical procedure. During the procedure, signs/symptoms of MH will develop. The learner will need to identify these signs, and begin the MHAUS treatment protocol.
Patient History
Evan Patterson is a healthy 17-year-old patient scheduled for a large umbilical hernia repair. He takes no medications routinely. He was intubated successfully on the first attempt under direct laryngoscopy. Baseline vitals BP 120/70, HR 65 Temp 37.8 C. Weight is 155 lbs (70.3 Kg). Allergies: NKDA. Baseline Labs Hct = 40; WBC = 16.8; RBC = 5; Albumin = 3.7. His past surgical history includes a tonsillectomy at age 7 without complications. His past medical history includes asthma. He was brought to the operating room with a working 20g IV in his hand. An IV induction was performed with propofol, fentanyl, and succinylcholine.
Learning Objectives
- Identify Malignant hyperthermia, and Discontinue MH Triggering agents
- Ensure prompt airway management
- Demonstrate need to call for: Help, MH Cart, Code Cart
- Use of MHAUS checklist
- Demonstrate recognition and treatment of associated acute electrolyte abnormalities if present
- Demonstrate effective leadership/teamwork and communication skills
- Dilute and administer the first dose of dantrolene within 10 minutes of decision to treat.
References
Larach MG, Gronert GA, Allen GC, Brandom BW, Lehman EB. Clinical presentation, treatment, and complications of malignant hyperthermia in North America from 1987 to 2006. Anesth Analg 2010; 110:498-507
Riazi S, Larach MG, Hu C, Wijeysundera D, Massey C, Kraeva N. Malignant hyperthermia in Canada:
characteristics of index anesthetics in 129 malignant hyperthermia probands. Anesth Analg 2014;118:381-87.
MHAUS Recommendations www.mhaus.org
