Case Scenario: Increased End-tidal Carbon Dioxide

Department of Anesthesiology, University of California-Davis, Davis, CA 95616, USA.
Anesthesiology (Impact Factor: 5.88). 02/2010; 112(2):440-6. DOI: 10.1097/ALN.0b013e3181ca7c38
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Available from: Albert Urwyler, Jun 27, 2015
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    • "The unexplained elevation of end-tidal carbon dioxide may be the earliest and the most common sign of MH episode in the intubated and mechanically ventilated patient [37]. Especially, when succinylcholine is used as the relaxing agent, abrupt rise of end-tidal carbon dioxide can be observed [38]. However, with a decline in the use of succinylcholine, a more gradual rise in CO2, rather than an abrupt rise are often noted, and it is possible to mask this rise by increasing the minute ventilation [39]. "
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    ABSTRACT: Malignant hyperthermia (MH) is an uncommon, life-threatening pharmacogenetic disorder of the skeletal muscle. It presents as a hypermetabolic response in susceptible individuals to potent volatile anesthetics with/without depolarizing muscle relaxants; in rare cases, to stress from exertion or heat stress. Susceptibility to malignant hyperthermia (MHS) is inherited as an autosomally dominant trait with variable expression and incomplete penetrance. It is known that the pathophysiology of MH is related to an uncontrolled rise of myoplasmic calcium, which activates biochemical processes resulting in hypermetabolism of the skeletal muscle. In most cases, defects in the ryanodine receptor are responsible for the functional changes of calcium regulation in MH, and more than 300 mutations have been identified in the RYR1 gene, located on chromosome 19q13.1. The classic signs of MH include increase of end-tidal carbon dioxide, tachycardia, skeletal muscle rigidity, tachycardia, hyperthermia and acidosis. Up to now, muscle contracture test is regarded as the gold standard for the diagnosis of MHS though molecular genetic test is used, on a limited basis so far to diagnose MHS. The mortality of MH is dramatically decreased from 70-80% to less than 5%, due to an introduction of dantrolene sodium for treatment of MH, early detection of MH episode using capnography, and the introduction of diagnostic testing for MHS. This review summarizes the clinically essential and important knowledge of MH, and presents new developments in the field.
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    ABSTRACT: In elk nummer van Critical Care vindt u een casus die de verschillende fases van een behandeling laat zien. Dit keer de succesvolle behandeling van een 46-jarige man met maligne hyperthermie.
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  • Anesthesiology 09/2010; 113(3):758; author reply 758-9. DOI:10.1097/ALN.0b013e3181eab908 · 5.88 Impact Factor
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