Resumen y ultimos conceptos sobre hipertermia maligna
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2016Full description
comele.pacientii comatosi
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sop hipertermiFull description
hanya pembahasan saja
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Hipertermia Maligna y Miopatías Mariana Kahn Chernilo Becada Anestesiología Universidad Univer sidad de Chile
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Síndrome hipermetabólico Clásicamentee se asocia al Clásicament a l uso de anestésic anestésico o inhalatorio alkano (halotano) y relajant relajantee muscular depolarizante (succinilcolina) •
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Rápido incremento de T° corporal hasta 1°/5 min
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Acidosis extrema incremento no controlado del
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Incidencia tan frecuente como de uno en 5000 o tan raro como como uno en e n 100000 administraciones de anestesia general con anestésicos gatillantes. gatillantes. Sin embargo, por su característica caract erística de síndrome genético dominante se calcula que la prevalencia de pacientes susceptibles puede ser tan alta como 1:3000 pacientes
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Mortalidad históricamente 70%
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Enfermedad hereditaria, autosómica dominante, de penetrancia incompleta y expresividad variable Afecta al músculo esquelético 50-80% de los pacientes con HM + Bp músculo (+) tienen una o más de las 110 mutaciones del gen receptor
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Desregulación del acoplamiento excitoexcitocontráctil del músculo esquelético RyR1 es un canal de alta conductancia que regula la liberacion de Ca2+ desde el retículo sarcoplásmico Su regulación esta dada por dos cationes Ca2+ y Mg2+ La mutación produce una alteración en su mecanismo de inhibición •
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Aumento actividad de bombas y transportadores que retiran el Ca2+ intracelular mayor consumo ATP liberación excesiva de calor Hipertermia Incremento metabolismo aerobio y anaerobio aumento producción CO2 y lactato acidosis respiratoria respira toria y metabólica
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Rabdomiolisis mioglobinuria falla renal
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Fármacos gatillantes reconocidos •
Halotano
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Fármacos considerados seguros •
Óxido nitroso
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Presentación Clínica •
Aumento de la excreción de CO2 ETCO2 aumenta al
doble o triple, con VM constante constante
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Taquicardia
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Taquipnea
síntoma cardinal
Aparecen posterior al incremento del CO2
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Manejo
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Tratar la hiperkalemia: calcio, bicarbonato, glucosa IV e
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