Hipertermia maligna

padlock-lockedLog in or subscribe to access all of BMJ Best Practice
Última revisão: 21 Abr 2022
Última atualização: 29 Jan 2020

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

  • presença de fatores de risco
  • exposição a um anestésico inalatório forte e/ou succinilcolina (suxametônio)
  • susceptibilidade à HM
  • episódio prévio de HM
  • história familiar positiva
  • ventilação-minuto aumentada
  • temperatura central elevada
  • rigidez muscular
Mais principais fatores diagnósticos

Outros fatores diagnósticos

  • taquicardia
  • débito urinário diminuído
  • sudorese excessiva com exercício
  • cãibras musculares
  • episódios espontâneos de rigidez muscular intensa
Outros fatores diagnósticos

Fatores de risco

  • exposição a um anestésico inalatório forte e/ou succinilcolina (suxametônio)
  • susceptibilidade à HM
  • episódio prévio de HM
  • história familiar positiva
  • doença do esforço por calor
Mais fatores de risco
padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Investigações diagnósticas

Primeiras investigações a serem solicitadas

  • descontinuação do anestésico inalatório
  • dióxido de carbono exalado, oxigênio e consumo de oxigênio (diferença de concentração do oxigênio inspirado-expirado)
  • gasometria venosa
  • eletrólitos séricos
  • creatinina sérica
  • tentativa terapêutica com dantroleno intravenoso
  • creatina quinase
  • urinálise
  • mioglobina urinária
  • plaquetas
  • tempo de protrombina
Mais primeiras investigações a serem solicitadas

Investigações a serem consideradas

  • teste de contratura a cafeína-halotano (TCCH)
  • teste de contratura in vitro (TCIV)
  • teste genético
  • rastreamento de deficiências de enzimas musculares
Mais investigações a serem consideradas
padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Algoritmo de tratamento

Aguda

induzida por anestesia inalatória

induzida pelo exercício ou calor

padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Colaboradores

Autores

Christopher M. Edwards, MD

Assistant Professor

Department of Anesthesiology

University of Florida College of Medicine

Gainesville

FL

Declarações

CME volunteers for the Malignant Hyperthermia Association of the United States (MHAUS), including as a consultant for the malignant hyperthermia hotline. CME is co-author of a chapter on malignant hyperthermia in Fuhrman & Zimmerman’s Pediatric Critical Care, 6th ed., Elsevier.

Nikolaus Gravenstein, MD

Professor

Department of Anesthesiology

University of Florida College of Medicine

Gainesville

FL

Declarações

NG is medical adviser/consultant for LifeFlow (410 Medical) and Teleflex, and has received funding from Merck for delivering education lectures to Merck employees. NG is Medical Director of the North American Malignant Hyperthermia Registry.

Agradecimentos

Christopher M Edwards and Nikolaus Gravenstein would like to gratefully acknowledge Dr Barbara W. Brandom and Dr Lena Mayes, the previous contributors to this topic.

Declarações

LM declares that she has no competing interests. BWB has been reimbursed by the not-for-profit sponsor of the North American MH Registry (NAMHR), the Malignant Hyperthermia Association of the United States (MHAUS) for attending meetings related to the management of the NAMHR. For the past 16 years, BWB received grants from MHAUS to maintain the NAMHR. BWB was the unpaid director of the NAMHR, until Jul 2016. BWB has given lectures and prepared educational materials for her previous employer, the Department of Anesthesiology in the University of Pittsburgh. As of 1 July, 2016, BWB retired from that employment. BWB has published papers and prepared educational materials for MHAUS, with the help of other volunteers for MHAUS. BWB sponsored LM for an award granted by the American Society of Anesthesiologists. This award allowed LM to travel to several medical centers that were active in the diagnosis of MH, as well as to the NAMHR to improve her understanding of this syndrome. This is part of BWB's mentoring of younger anesthesiologists. BWB is also an author of a number of references cited in this topic.

Revisores

Henry Rosenberg, MD

Director

Department of Medical Education and Clinical Research

Saint Barnabas Medical Center

Livingstone

NJ

Declarações

HR declares that he has no competing interests.

Philip Hopkins, MD

Professor of Anesthesia

University of Leeds

Academic Unit of Anesthesia

St James's University Hospital

Leeds

UK

Declarações

PH is an author of a number of references cited in this topic.

Thierry Girard, MD

Associate Professor

Perioperative Patient Safety

Department of Biomedicine

University Hospital Basel

Basel

Switzerland

Declarações

TG declares that he has no competing interests.

Joseph Tobin, MD, FAAP, FCCM

Professor and Chairman

Department of Anesthesiology

Wake Forest University School of Medicine

Winston-Salem

NC

Declarações

JT is an author of a number of references cited in this topic.

  • Diagnósticos diferenciais

    • Rabdomiólise não associada a hipertermia maligna (HM)
    • Atrofia muscular por desuso
    • Miotonia
    Mais Diagnósticos diferenciais

  • Diretrizes

    • Malignant hyperthermia 2020
    • Consensus guidelines on perioperative management of malignant hyperthermia suspected or susceptible patients from the European Malignant Hyperthermia Group
    Mais Diretrizes
  • padlock-lockedLog in or subscribe to access all of BMJ Best Practice

O uso deste conteúdo está sujeito ao nosso aviso legal