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标题: 2010年BJA最新欧洲恶性高热处理指南 [打印本页]

作者: 华西小卒    时间: 2010-9-16 20:05
标题: 2010年BJA最新欧洲恶性高热处理指南
  Br J Anesthesia 最新刊登的欧洲恶性高热处理指南,请大家鉴赏。
Recognizing and managing a malignant hyperthermia crisis: guidelines from the European Malignant Hyperthermia Group
K. P. E. Glahn1,*, F. R. Ellis2, P. J. Halsall3, C. R. Müller4, M. M. J. Snoeck5, A. Urwyler6 and F. Wappler7
1Danish Malignant Hyperthermia Centre, Department of Anaesthesia, University Hospital Herlev, Copenhagen, Denmark2University of Leeds, Leeds, UK3MH Investigation Unit, St James University Hospital, Leeds, UK4Department of Human Genetics, University of Würzburg, Germany5MH Investigation Unit, Nijmegen, The Netherlands6Department of Anaesthesia and Research, University of Basel, Switzerland7Department of Anaesthesiology and Intensive Care Medicine, Hospital Cologne-Merheim, University Witten-Herdecke, Cologne, Germany
*Corresponding author. E-mail: kpeg{at}dadlnet.dk
Accepted July 5, 2010.
Abstract
Survival from a malignant hyperthermia (MH) crisis is highly dependent on early recognition and prompt action. MH crises are very rare and an increasing use of total i.v. anaesthesia is likely to make it even rarer, leading to the potential risk of reduced awareness of MH. In addition, dantrolene, the cornerstone of successful MH treatment, is unavailable in large areas around the world thereby increasing the risk of MH fatalities in these areas. The European Malignant Hyperthermia Group collected and reviewed all guidelines available from the various MH centres in order to provide a consensus document. The guidelines consist of two textboxes: Box 1 on recognizing MH and Box 2 on the treatment of an MH crisis.

2010年BJA最新欧洲恶性高热处理指南.rar

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作者: 华西小卒    时间: 2010-9-16 20:07
Recognizing and managing a malignant hyperthermia crisis: guidelines from the European Malignant Hyperthermia Group

Next Section
Abstract

Survival from a malignant hyperthermia (MH) crisis is highly dependent on early recognition and prompt action. MH crises are very rare and an increasing use of total i.v. anaesthesia is likely to make it even rarer, leading to the potential risk of reduced awareness of MH. In addition, dantrolene, the cornerstone of successful MH treatment, is unavailable in large areas around the world thereby increasing the risk of MH fatalities in these areas. The European Malignant Hyperthermia Group collected and reviewed all guidelines available from the various MH centres in order to provide a consensus document. The guidelines consist of two textboxes: Box 1 on recognizing MH and Box 2 on the treatment of an MH crisis.


Key wordsKey points

Previous SectionNext Section

The first known case of malignant hyperthermia (MH) survived because the anaesthetist quickly stopped anaesthesia and surgery when he observed a set of strange clinical signs. However, he was already alerted to a potential problem because of a preoperative history of several anaesthesia-related deaths in the patient's family.1 The key lesson learnt from this event is as relevant today as it was back in 1960: survival from an MH crisis is highly dependent on early recognition and prompt action.

MH crises are very rare and an increasing use of total i.v. anaesthesia (TIVA) using non-triggering agents in many Western European countries is likely to make it even rarer, leading to the potential risk of reduced awareness of MH among anaesthetists and theatre staff. However, recent reports showed that the frequency of MH episodes has increased, and due to the autosomal-dominant inheritance in humans, prevalence of MH can be estimated up to 1:3000.2 In addition, dantrolene, the cornerstone of successful MH treatment, is unavailable in many institutions in Eastern European countries and in large areas around the world due to its cost, thereby increasing the risk of MH fatalities in these areas.

The European Malignant Hyperthermia Group (EMHG), a leading international society working on MH, has therefore decided to publish guidelines for the detection and handling of an MH crisis. Many institutions have drawn up local guidelines and most countries with an MH Investigation Unit have developed national guidelines. The EMHG Executive committee collected and reviewed all guidelines available from the various MH centres in order to provide a consensus document. It is hoped that this will be helpful, especially for countries having no MH centre and therefore no national guidelines.

While recognizing that it is impossible to stipulate the exact set-up for dealing with MH for each institution worldwide, we are, nevertheless, convinced that the EMHG guidelines will provide a sound basis to help anaesthetists and theatre staff in Europe and around the world ensure that best practice is followed and enable them to plan ahead.

The guidelines consist of two textboxes: Box 1 on recognizing MH and Box 2 on the treatment of an MH crisis.

Box 1 EMHG Guidelines: Recognizing an MH crisis

Early recognition of an impending MH crisis and its immediate treatment is essential for the patient's survival. As the clinical signs associated with MH are not unique, anaesthetists must be able to recognize a pattern of signs in order to make a rapid diagnosis.

Any patient may develop MH during or shortly after an anaesthetic where trigger agents are used—this can occur even in patients who have had uneventful general anaesthesia previously.

Trigger agents are

Clinical signs


Early signs
Later signs
Differential diagnosis

Box 2 EMHG Guidelines: Managing an MH Crisis

Start treatment as soon as an MH crisis is suspected.

The clinical presentation of MH varies and treatment should be modified accordingly.


Treatment
Symptomatic treatment
Consult your local Malignant Hyperthermia Investigation Unit about the case

Patients suspected of being MH-susceptible should undergo diagnostic testing using in vitro contracture testing (IVCT) at a designated MH-laboratory (www.emhg.org).


Action cards adapted for local conditions and resources can be extremely helpful in dealing with an MH crisis. Such a system, designed by the Australian and New Zealand MH group (MHANZ),3 has proved to be a success in full-scale simulation and can save valuable time.

It is important that once a case of MH is suspected, either because of a full-blown MH crisis or a set of symptoms suggestive of MH which resolved on stopping any trigger agents, the patient and their relatives should always be referred to a regional or national MH centre for further investigation wherever possible. The EMHG has previously published guidelines for diagnosing MH susceptibility using the IVCT test and genetic testing when indicated.45


作者: chengd996    时间: 2010-9-17 15:23
老兄,能费神翻译一下吗?英文水平有限,请谅解。深表感谢!
作者: frog_0612    时间: 2017-9-17 00:06
现在在线翻译很方便了
多谢分享




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