Friday, March 13, 2009

Malignancy

You are about 15 minutes into a routine laparoscopic cholecystectomy for symptomatic cholelithiasis in a 45 year old woman when you hear the beeping of the heart monitor speed up. You are still dissecting out Calot's triangle and have not yet cut or clipped any ducts or arteries. As far as you can tell, hemostasis is fine. The anesthesiologist says, "We have a problem. She has masseter stiffness, sinus tachycardia, skin cyanosis with mottling, and fever."

Challenge: Without the right therapy, the patient is at risk for hypotension, dysrhythmias, rhabdomyolysis, electrolyte abnormalities, DIC, acidosis, and cardiac arrest. The anesthesiologist should be grabbing what drug?

Image is in the public domain.

2 comments:

Alex said...

dantrolene?

Craig Chen said...

Nice job!
-
Malignancy

Malignant hyperthermia is a rare genetic disorder (autosomal dominant in 50% cases) involving a mutation in the skeletal muscle ryanodine receptor (calcium channel in the sarcoplasmic reticulum). It is triggered by anesthetic agents like succinylcholine, halothane, and fluranes with an onset usually within one hour of anesthetic administration. Treatment is dantrolene which blocks calcium release from the sarcoplasmic reticulum.

Sources: UpToDate; Wikipedia.