La enfermería de quirófano ante la Hipertermia Maligna. ¿Estamos preparados?

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Abstract

Resumen Objetivo principal: Evaluar el conocimiento de la Hipertermia Maligna (HM) entre los profesionales de Enfermería de quirófano. Metodología: Estudio descriptivo transversal con 169 profesionales de Enfermería de quirófano. Resultados principales: La puntuación total de los cuestionarios alcanzó un promedio de 4,8 (±2,18) puntos sobre 10 totales. Disponer de un protocolo para la asistencia de episodios de HM, se relacionó de forma significativa con un conocimiento adecuado. Conclusión principal: Los profesionales de Enfermería de quirófano presentan unos inadecuados niveles de conocimiento sobre la HM y su manejo. Es necesaria una mejora en la preparación de las enfermeras para atender a un paciente en crisis de HM.

Translated abstract

Abstract Main objective: Assessing knowledge levels of the surgical nurses regarding Malignant Hyperthermia (MH) and its management. Methodology: Cross-sectional descriptive study among 169 surgical nurses. Main results: The total score of the questionnaires reached an average of 4.8 (± 2.18) points out of 10 total. Having an standart operating procedute for the assistance of MH episodes was significantly related to adequate knowledge. Main conclusion: Surgical nurses have inadequate levels on managing MH and delivering inmediate care. It is necessary to provide specific trainning on MH for surgical nurses to prepare them to safely assist patients suffering MH crisis.

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Malignant hyperthermia: a review

Henry Rosenberg, Neil Pollock, Anja Schiemann … (2015)

Malignant hyperthermia (MH) is a pharmacogenetic disorder of skeletal muscle that presents as a hypermetabolic response to potent volatile anesthetic gases such as halothane, sevoflurane, desflurane, isoflurane and the depolarizing muscle relaxant succinylcholine, and rarely, in humans, to stressors such as vigorous exercise and heat. The incidence of MH reactions ranges from 1:10,000 to 1: 250,000 anesthetics. However, the prevalence of the genetic abnormalities may be as great as one in 400 individuals. MH affects humans, certain pig breeds, dogs and horses. The classic signs of MH include hyperthermia, tachycardia, tachypnea, increased carbon dioxide production, increased oxygen consumption, acidosis, hyperkalaemia, muscle rigidity, and rhabdomyolysis, all related to a hypermetabolic response. The syndrome is likely to be fatal if untreated. An increase in end-tidal carbon dioxide despite increased minute ventilation provides an early diagnostic clue. In humans the syndrome is inherited in an autosomal dominant pattern, while in pigs it is autosomal recessive. Uncontrolled rise of myoplasmic calcium, which activates biochemical processes related to muscle activation leads to the pathophysiologic changes. In most cases, the syndrome is caused by a defect in the ryanodine receptor. Over 400 variants have been identified in the RYR1 gene located on chromosome 19q13.1, and at least 34 are causal for MH. Less than 1 % of variants have been found in CACNA1S but not all of these are causal. Diagnostic testing involves the in vitro contracture response of biopsied muscle to halothane, caffeine, and in some centres ryanodine and 4-chloro-m-cresol. Elucidation of the genetic changes has led to the introduction of DNA testing for susceptibility to MH. Dantrolene sodium is a specific antagonist and should be available wherever general anesthesia is administered. Increased understanding of the clinical manifestation and pathophysiology of the syndrome, has lead to the mortality decreasing from 80 % thirty years ago to <5 % in 2006.

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Malignant hyperthermia deaths related to inadequate temperature monitoring, 2007-2012: a report from the North American malignant hyperthermia registry of the malignant hyperthermia association of the United States.

Marilyn Larach, Barbara W Brandom, Gregory Allen … (2014)

AMRA (adverse metabolic or muscular reaction to anesthesia) reports submitted to The North American Malignant Hyperthermia Registry of the Malignant Hyperthermia Association of the United States from 1987 to 2006 revealed a 2.7% cardiac arrest and a 1.4% death rate for 291 malignant hyperthermia (MH) events. We analyzed 6 years of recent data to update MH cardiac arrest and death rates, summarized characteristics associated with cardiac arrest and death, and documented differences between early and recent cohorts of patients in the MH Registry. We also tested whether the available data supported the hypothesis that risk of dying from an episode of MH is increased in patients with inadequate temperature monitoring.

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Malignant hyperthermia crisis: optimizing patient outcomes through simulation and interdisciplinary collaboration.

Cindy L. Cain, Matthias L. Riess, Lynn Gettrust … (2014)

Malignant hyperthermia (MH) is a rare, life-threatening event. Many clinicians are unprepared to manage an MH crisis in the perioperative setting because it requires the use of low-frequency, high-risk skills and procedures. Simulation is a recognized educational method for cumulative and integrative learning in a safe environment that resembles real-life clinical scenarios. The aim of this quality improvement project was to provide simulation-based learning to perioperative personnel to educate them in the early recognition, treatment, and management of MH. An interdisciplinary team developed an MH education plan. Implementation of the plan involved a two-part training: an educational session, and a role-playing scenario using high-fidelity OR simulation. Simulation teaching provided OR personnel with an opportunity for skill development, teamwork, interdisciplinary communication, and problem solving. Personnel responded favorably and identified positive outcomes, such as role clarity, improved anticipatory response, and overall team cohesion. In addition, the project included updating the MH cart and writing the hospital's MH policy.

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Author and article information

Journal

Journal ID (publisher-id): index

Title: Index de Enfermería

Abbreviated Title: Index Enferm

Publisher: Fundación Index (Granada, Granada, Spain )

ISSN (Print): 1132-1296

ISSN (Electronic): 1699-5988

Publication date (Print and electronic): June 2020

Volume: 29

Issue: 1-2

Pages: 28-32

Affiliations

[1] Oviedo Asturias orgnameHospital Universitario Central de Asturias España

[4] Mieres Asturias orgnameHospital Vital Álvarez Buylla España

[5] Avilés Asturias orgnameHospital San Agustín España

[3] Parres Asturias orgnameHospital Grande Covián España

[2] Oviedo Asturias orgnameInstituto de Investigación Sanitaria del Principado de Asturias España

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Publisher ID: S1132-12962020000100007 Publisher ID: S1132-1296(20)02900100007

SO-VID: 649eb983-8160-4cde-bf40-ced951705a4f

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This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 International License.

History

Date accepted : 22 February 2020

Date received : 12 December 2019

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Figures: 0, Tables: 0, Equations: 0, References: 19, Pages: 5

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La enfermería de quirófano ante la Hipertermia Maligna. ¿Estamos preparados? Translated title: Surgical Nurse on Malignant Hyperthermia. Are we prepared?

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Most cited references 14

Malignant hyperthermia: a review

Malignant hyperthermia deaths related to inadequate temperature monitoring, 2007-2012: a report from the North American malignant hyperthermia registry of the malignant hyperthermia association of the United States.

Malignant hyperthermia crisis: optimizing patient outcomes through simulation and interdisciplinary collaboration.

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