The incomprehensible diagnosis of "malignant hyperthermia"
One of the causes of death on the operating table is a rare disease "Malignant hyperthermia."At the heart of this disease are violations of metabolic processes in the muscle tissue, which appear as a result of general anesthesia. Her symptoms are shortness of breath, fever and palpitation, which can lead to death.
Malignant hyperthermia is a disease transmitted by inheritance. It does not manifest itself until the moment when a person receives a dose of anesthesia. Even the fact that the disease did not manifest itself in the parents, if they were anesthetized does not at all mean that they are not carriers of the gene that passed to the children and will manifest themselves in them.
This disease does not appear from nowhere. To develop it, a genetic predisposition or neuromuscular disease is necessary. A very serious signal for doctors should be that one of the relatives of the patient who should be anesthetized died during anesthesia, becausethere is a possibility that it was death from malignant hyperthermia. If you have an operation, you need to ask your relatives about whether there were people in your family who were ill during anesthesia, and even more so if someone died during the operation. If such cases have been reported, the doctor should be informed.
In addition, malignant hyperthermia may occur in patients suffering from Becker muscular dystrophy, Duchenne muscular dystrophy, as well as some other neuromuscular diseases.
Malignant hyperthermia is not treated. The only effective medicine that helps to save a patient who had signs of this disease during anesthesia is dantrolene. In the United States, for example, there is a ban on the introduction of anesthesia, if there is no dantrolene in the hospital for some reason. However, in Russia this drug is not registered, and therefore not sold.
Since the only remedy for malignant hyperthermia in Russia is prohibited, the only thing that remains is to prevent this disease. If your family has had cases of intolerance to anesthesia, or if you have a neuromuscular disease, you should definitely notify the doctor. If you have an operation, then there are all chances that malignant hyperthermia will appear during anesthesia. There is an operation in oncology or, say, an ordinary appendicitis, it does not matter.
If a patient with a predisposition to this disease gets to the operating table, the doctor( and the patient himself) should always pay attention to such moments:
- for the anesthesia of such patients it is strictly forbidden to use such drugs as muscular dithilan relaxant and inhalation antiseptics. The remaining drugs for anesthesia are practically safe for malignant hyperthermia;
- before the introduction of the patient into anesthesia from the anesthesia and respiratory apparatus, the evaporator should be removed( this is the container into which the inhalation anesthetic is poured);
- the system of hoses, through which the patient is given a breathing mixture, must be replaced with a new one;
- before connecting to the patient anesthesia and breathing apparatus, it should be about half an hour to keep it turned on "idle".These actions are necessary in order to clean the device of inhalation anesthetics, which were used during the previous operation.
All these activities will help reduce the risk for patients who are theoretically threatened with malignant hyperthermia. Treatment of this serious complication of anesthesia in our country is impossible.
Unfortunately, in Russia there is no statistics of cases of malignant hyperthermia. However, there are such statistics in the US, and it is disappointing: about 200 cases a year. If we proceed from the data on the number of the population, in Russia there should be about 100 such cases. At the same time, in the United States, malignant hyperthermia is treated with dantrolene, which significantly reduces the death rate from this disease. But in Russia this drug is not available, and if a person has started an attack during anesthesia, the chances of saving are minimal.