Special Considerations in the Perioperative Environment for Registered Nurses

What is Malignant Hyperthermia (MH)

  1. It is a complication from volatile anesthetic agents and succinylcholine that is rare but can be life-threatening.
  2. It is an inherited condition of the skeletal muscles.
  3. Triggering agents include halothane, isoflurane, sevoflurane, desflurane, and the muscle relaxant succinylcholine.
Signs and Symptoms of MH

Hypercarbia

Tachycardia

Tachypnea which may not be seen in a paralyzed patient

Muscle stiffness or rigidity

Hypoxia and dark (desaturated) blood in the operative field

Unstable or elevated blood pressure

Cardiac dysrhythmias

Changes in the CO2 absorbent (temperature/colour)

Metabolic and respiratory acidosis

Peripheral mottling, cyanosis, or sweating

Rising body temperature (1°C – 2°C every five minutes)

Myoglobinuria

Hyperkalemia, hypercalcemia, lactic acidemia

Pronounced elevation in creatine kinase level

(Campbell, 2019)

Preoperative Assessment

The circulating nurse is responsible for performing a preoperative assessment to identify if a patient has any predisposing risk factors for malignant hyperthermia.

The nurse looks for a patient history or family history of the following:

  1. An undefined incident during an anesthesia
  2. An undefined critical event and/or death of a relative during anesthesia
  3. Muscular abnormalities
  4. Heatstroke
  5. Myopathy or acquired muscle disease, rheumatoid arthritis

Nurses should review patients’ records for a Caffeine Halothane Contracture Test (CHCT) positive result from Toronto General Hospital.

(ORNAC, 2021)