Malignant heat caused by anaesthesia: fatal crisis hidden in surgery
In the course of modern medical surgery, anaesthesia is an essential link that allows patients to undergo surgery without pain. However, there is a rare but extremely dangerous complication — anaesthesia-induced virulent heat, such as a beast hidden in the shadows, which can pose a serious threat to the lives of the patients at any time.
I. What’s anaesthesia causing the heat?
Anaesthesia-induced hyperheat is a genetic muscle metabolic abnormality that triggers a series of life-threatening physiological reactions in the patient ‘ s body. Normally, our muscle constrictions and stretches are finely regulated to maintain normal physical activity and metabolism. However, in the case of malignant high-hot patients, this regulatory mechanism is completely out of control with the use of narcotic drugs.
Inducing factors
Some inhalant anesthesia and muscle relaxants are the main triggers. Common inhaled anesthesia include fluorine, fluorones, hexafluorones, etc., while amber choline is a muscular laxant that is prone to hyperheating. These drugs are safe for ordinary patients, but for patients with specific genetic defects, they are like opening the key to the Pandora Box.
III. METHODOLOGY
It is rooted in genetic anomalies. Most patients have mutations of the RYR1 gene in the skeletal skeletal musculo-sculptural network, with a few associated with other mutations of the 19th chromosome. During normal muscle constriction, the ryanodine receptor plays a key role in regulating the release of calcium ions within the muscular net. However, mutation receptors, after exposure to the induction drug, result in large and persistent releases of calcium ions within the muscular net to the cell mass. This results in continuous muscle contraction and a sharp increase in muscle metabolism, which produces a large amount of heat and lactation, leading to a series of severe physiological reactions. IV. Clinical performance
1. Incidence in body temperature
This is one of the most visible symptoms of the severe heat. Patient temperature can rise dramatically in a short period of time and at alarming speed. Body temperature increases often exceed 40°C or even higher, with a temperature increase of up to 1°C or higher every 5 minutes. This rapid increase in body temperature is due to the accumulation of heat from excessive muscle constriction in the body, which is unable to respond in a timely manner to the dissipation mechanism.
Cardiovascular system anomalies
The heart rate is expected to accelerate significantly, exceeding 160 times per minute, and heart disorders are common. Excessive heart rates have dramatically increased the burden on the heart, which has struggled to maintain the blood cycle but is less efficient. At the same time, blood pressure may be unstable and may rise at an early stage, with a decrease in blood pressure as the condition deteriorates, seriously affecting blood injections throughout the body.
Respiratory problems
Rapid and difficult breathing is typical. Patients may experience increased respiratory frequency and a change in respiratory depth, accompanied by carbon dioxide retention and low oxygen haematosis. In serious cases, respiratory convulsions further exacerbate respiratory disorders, resulting in respiratory failure.
4. Strength and injury
The muscles are subject to a strong straight contraction, which spreads from local muscles to the whole body. This strong state of condition not only results in rigidity, but also in severe muscle damage. The levels of serostatase (CK) are expected to increase significantly, with large amounts of myoglobin released into the blood. When myioglobin is excreted through the kidney, it is possible to block the kidney tube and cause acute kidney failure.
5. Alkyl balance disorder
Patients experience severe metabolic and respiratory acid poisoning as a result of muscle metabolism and high levels of lactating acid, while respiratory impairments affect CO2 emissions. High-carbonate haematoemia further harms the nervous system by expanding the cerebrovascular vessels and increasing the internal pressure of the skull.
V. Diagnosis and identification
The diagnosis is based on the clinical performance of the patient, family history and anomalies in the anaesthesia process. There is a high level of suspicion of malignant high fever if there are typical signs of a sharp rise in body temperature and muscle strength within a short period of time after anaesthesia. The identification of the diagnosis needs to exclude other conditions that may lead to similar symptoms, such as infection, blood transfusion response, amphibians, etc.
Treatment
1. Immediate cessation of induced drugs
The need to stop the use of suspicious narcotic drugs as soon as there is a suspicion of an acute fever is a key first step in preventing further deterioration.
2. Use of special effects
Dancorin is an effective drug for the treatment of malign heat. It can act on the muscular net, inhibiting the release of calcium ions, thus reducing muscle strength and heat generation. The dosage used by Danchurlin needs to be adjusted to the patient ‘ s weight and severity.
3. Active cooling
Physical cooling methods, such as the use of ice bags, ice blankets, etc., to cover patients ‘ bodies and reduce body temperature. At the same time, cooling can be assisted by infusion of low temperature liquids.
4. Respiration and circulation support
Keep the air lanes open, give high-flow oxygen inhalation, and, if necessary, provide pipe intubation and mechanical ventilation to correct respiratory disorders. For the cardiovascular system, indicators such as heart rate, blood pressure etc. need to be closely monitored, blood pressure stability is maintained using vascularly active drugs to correct heart disorders.
5. Correcting alkaline balance and electrolyte disorders
Based on blood tests, sodium carbonate is updated in a timely manner to correct acid poisoning, with attention to electrolyte such as potassium, calcium, etc., to maintain internal environmental stability.
VII. Prevention strategies
Genetic testing and screening should be carried out prior to surgery for patients with malignant high-hot family history. Anesthetists are required to enquire in detail about the patient ‘ s family history prior to the operation, and for high-risk patients, the use of anaesthetic drugs that may induce severe heat should be avoided, the choice of relatively safe anaesthesia programmes, such as regional anesthesia or the use of alternative methods such as anaesthesia, which are entirely intravenous. In sum, the high levels of malignant heat caused by anaesthesia, although rare, are a high death rate and a high degree of disablingness that require our great attention. Medical personnel need to raise awareness and vigilance about the disease, and patients and their families should cooperate actively in pre-operative assessment and prevention to ensure the life and physical well-being of the surgical patients.
