Anaes Vivas · Malignant hyperthermia
Data viva — the rising ETCO2 and temperature trace
A data viva on the MH monitoring signature — the rising ETCO2 unresponsive to increased ventilation (the sentinel sign, a hallmark of increased metabolic CO2 production), the parallel temperature rise, and the immediate differential of an apparatus fault versus a true hypermetabolic crisis.
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ANZCAFRCAABAEDAIC
Prompt
An anaesthetic monitoring display showing a capnography trace with an end-tidal carbon dioxide climbing steeply from 4.5 to 8.5 kPa over fifteen minutes despite an increased respiratory rate, alongside a core temperature trace rising by more than a degree in ten minutes.
Stimulus
A monitoring display from a patient under sevoflurane anaesthesia. The capnograph shows a normal square-wave trace, but the end-tidal carbon dioxide is climbing steeply — from 4.5 to 8.5 kPa over fifteen minutes — despite the ventilator rate and tidal volume having been increased. A core temperature trace rises in parallel, by more than a degree in ten minutes.
References3ShowHide
- [2]Larach MG, Gronert GA, Allen GC, Brandom BW, Lehman EB. Clinical presentation, treatment, and complications of malignant hyperthermia in North America from 1987 to 2006. Anesthesia & Analgesia, 2010.PMID 20081135
- [4]Larach MG, Brandom BW, Allen GC, Gronert GA, Lehman EB. Malignant hyperthermia deaths related to inadequate temperature monitoring, 2007-2012: a report from the North American Malignant Hyperthermia Registry of MHAUS. Anesthesia & Analgesia, 2014.PMID 25268394
- [5]Bersten AD, Soni N (eds) Oh's Intensive Care Manual. 8th edition, Elsevier, 2018.