الفهرس | Only 14 pages are availabe for public view |
Abstract Malignant hyperthermia susceptibility (MHS) is a pharmacogenetic disorder of skeletal muscle calcium regulation associated with uncontrolled skeletal muscle hypermetabolism. Manifestations of malignant hyperthermia (MH) are precipitated by certain agents, either conventional such as depolarizing muscle relaxant (specifically, succinylcholine) or even volatile anesthetics (e.g. isoflurane), and also can be triggered by certain newly discovered drugs including (serotonergic drugs, phosphodiesterase type III inhibitors, statins, ondansteron, methylene blue, tetracaine). The triggering substances release calcium stores from the sarcoplasmic reticulum and may promote entry of calcium from the myoplasm, causing contracture of skeletal muscles, glycogenolysis, and increased cellular metabolism, resulting in production of heat and excess lactate. Affected individuals experience: acidosis, hypercapnia, tachycardia, hyperthermia, muscle rigidity, compartment syndrome, rhabdomyolysis with subsequent increase in serum creatine kinase (CK) concentration, hyperkalemia with a risk for cardiac arrhythmia or even arrest, and myoglobinuria with a risk for renal failure. MH may occur in the early postoperative period and can recur in the intensive care unit in following 24 to 48 hours. Without proper and prompt treatment with dantrolene sodium, mortality is extremely high. |